Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN11012901 | FL |
NPI | 1063175560 |
---|---|
Provider Name | Tiffany Samantha Charlton |
First Address | Doral, FL 33122-1174 |
Second Address | Doral, FL 33122-1174 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2021 |
Last Update Date | 19/11/2021 |