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Individual

MS. TIFFANY TATIANA PENA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(305) 668-5522
Mailing address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(305) 668-5522

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9109748
FL

Other

Enumeration date
10/19/2016
Last updated
10/19/2016
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