Provider Demographics
NPI:1891192704
Name:WYNOHRADNYK, TIFFANY (NP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WYNOHRADNYK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MIKESELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9291 MERRIMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-3029
Mailing Address - Country:US
Mailing Address - Phone:623-203-1976
Mailing Address - Fax:
Practice Address - Street 1:9291 MERRIMOOR BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-3029
Practice Address - Country:US
Practice Address - Phone:623-203-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991132-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health