Provider Demographics
NPI:1447685193
Name:POYNTER, TIFFANY N (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:N
Last Name:POYNTER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:POYTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1798 CUNNINGHAM ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2975
Mailing Address - Country:US
Mailing Address - Phone:904-378-6907
Mailing Address - Fax:
Practice Address - Street 1:5530 FIRESTONE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-1530
Practice Address - Country:US
Practice Address - Phone:904-436-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 34882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer