1386194769 NPI number — TIFFANY N CLAUSEN FNP-C

Table of content: TIFFANY N CLAUSEN FNP-C (NPI 1386194769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386194769 NPI number — TIFFANY N CLAUSEN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAUSEN
Provider First Name:
TIFFANY
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARROLL
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386194769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WOUNDTECH
Provider Second Line Business Mailing Address:
200 S PARK RD SUITE 200
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-986-2263
Provider Business Mailing Address Fax Number:
844-395-6696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WOUNDTECH
Provider Second Line Business Practice Location Address:
200 S PARK RD SUITE 200
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-986-2263
Provider Business Practice Location Address Fax Number:
844-395-6696
Provider Enumeration Date:
10/10/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  0001221474 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 9296965 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 9296965 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0024174099 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106170200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".