Provider Demographics
NPI:1528647781
Name:TIPTON, MIESHA MERIAH (APRN)
Entity type:Individual
Prefix:MS
First Name:MIESHA
Middle Name:MERIAH
Last Name:TIPTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 HEATHERHILL LN APT 2
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-8575
Mailing Address - Country:US
Mailing Address - Phone:561-889-1175
Mailing Address - Fax:
Practice Address - Street 1:5016 HEATHERHILL LN APT 2
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-8575
Practice Address - Country:US
Practice Address - Phone:561-889-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012277363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care