Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN9269514 | FL |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 9269514 | FL |
NPI | 1174821102 |
---|---|
Provider Name | Mrs. Tiffany Suzanne Gwartney |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Orlando, FL 32827-7402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2011 |
Last Update Date | 22/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003695100 | (05) | FL |