1508195207 NPI number — TIFFANY ROSE MARCUM OTR/L

Table of content: DR. ZEPEI XIE PT, DPT (NPI 1578491791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508195207 NPI number — TIFFANY ROSE MARCUM OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCUM
Provider First Name:
TIFFANY
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALVIN
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508195207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1833 SUNDOWN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAVARRE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32566-4315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-313-9243
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3387 GULF BREEZE PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-530-8189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2009

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: 225X00000X , with the licence number:  15394 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15394 . This is a "MANAGED CARE AND MEDICARE PART B" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".