Individual
TIFFANY WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
836 PRUDENTIAL DR STE 1103, JACKSONVILLE, FL 32207-8338
(904) 398-9499
(904) 398-0118
Mailing address
PO BOX 16568, JACKSONVILLE, FL 32245-6568
(904) 472-2300
(904) 472-2330
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME 117517
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012336900
—
FL
Enumeration date
06/08/2010
Last updated
11/06/2015
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