Individual
DR. TIFFANY M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-4225
(321) 434-4247
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-4225
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
ME115716
FL
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
P1769
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
ME115716
FL
208M00000X
Hospitalist Physician
P1769
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113907000
—
FL
01
—
PENDING
HFMG
FL
01
—
WP953
HFMG
FL
Enumeration date
02/01/2007
Last updated
02/23/2026
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