Individual
TIFFANY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
508 S HABANA AVE STE 340, TAMPA, FL 33609-4191
(813) 873-7367
(813) 875-9722
Mailing address
508 S HABANA AVE STE 340, TAMPA, FL 33609-4191
(813) 873-7367
(813) 875-9722
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
11020622
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115162200
—
FL
01
—
UAE19
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/08/2022
Last updated
12/03/2024
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