Individual
TIFFANY N MCCALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12794 FOREST HILL BLVD STE 9-10, WELLINGTON, FL 33414-4710
(561) 252-5398
Mailing address
12794 FOREST HILL BLVD STE 9-10, WELLINGTON, FL 33414-4710
(561) 252-5398
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
D0063078
MD
207P00000X
Emergency Medicine Physician
M7412
TX
207P00000X
Emergency Medicine Physician
Primary
ME103480
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
189741501
—
TX
05
—
408208700
—
MD
01
—
8AX740
BCBS
TX
01
—
8U4003
BCBS
TX
Enumeration date
04/01/2006
Last updated
01/13/2023
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