Provider Demographics
NPI:1285060079
Name:THEARD, TIFFANY M (MS, FNP-C, RN, CRRN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:THEARD
Suffix:
Gender:F
Credentials:MS, FNP-C, RN, CRRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5033 BEAUCLAIR ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2337
Mailing Address - Country:US
Mailing Address - Phone:262-496-6532
Mailing Address - Fax:
Practice Address - Street 1:5033 BEAUCLAIR ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-2337
Practice Address - Country:US
Practice Address - Phone:262-496-6532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9560905163W00000X
FLAPRN11012639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse