Provider Demographics
NPI:1861100448
Name:WESSEL, TIFFANY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WESSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6393 9TH ST N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-6610
Mailing Address - Country:US
Mailing Address - Phone:727-823-5555
Mailing Address - Fax:727-823-5509
Practice Address - Street 1:6393 9TH ST N STE 101
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-6610
Practice Address - Country:US
Practice Address - Phone:727-823-5555
Practice Address - Fax:727-823-5509
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program