Provider Demographics
NPI:1891238465
Name:ROSS, TIFFANY ILANA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ILANA
Last Name:ROSS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:ILANA
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9857 PALMA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3529
Mailing Address - Country:US
Mailing Address - Phone:305-753-1950
Mailing Address - Fax:
Practice Address - Street 1:9857 PALMA VISTA WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-3529
Practice Address - Country:US
Practice Address - Phone:057-531-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54036363A00000X, 363AM0700X
FL9119190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical