Provider Demographics
NPI:1447818190
Name:WRIGHT, TIFFANY LAUREN (FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LAUREN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 USHANT CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7437
Mailing Address - Country:US
Mailing Address - Phone:662-322-0541
Mailing Address - Fax:
Practice Address - Street 1:4500 FL-7
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33319-3331
Practice Address - Country:US
Practice Address - Phone:561-476-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9564961163W00000X
TN25285363LF0000X
FL11010595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse