Provider Demographics
NPI:1659116804
Name:STEAD, TIFFANY (APRN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:STEAD
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-752-0944
Mailing Address - Fax:
Practice Address - Street 1:1130 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1973
Practice Address - Country:US
Practice Address - Phone:321-752-0944
Practice Address - Fax:321-434-7590
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11033761363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTJ021OtherMEDICARE HF
FL123553900Medicaid