Provider Demographics
NPI:1356991848
Name:JONES, TIFFANY DYANN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DYANN
Last Name:JONES
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 S INTERNATIONAL PKWY STE 1301
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1402
Mailing Address - Country:US
Mailing Address - Phone:407-878-0022
Mailing Address - Fax:
Practice Address - Street 1:430 WAYMONT COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3503
Practice Address - Country:US
Practice Address - Phone:407-878-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant