Tiffany Dyal

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9111506 Issued in FL

Practice address

14546 Old Saint Augustine Rd Ste 409
Jacksonville, FL 32258-5473

Phone

(904) 388-6518

Fax

(904) 384-1005

NPI assigned

Jul 6, 2018

Last updated

Jun 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IIEEBD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St Vincents Ambulatory Care Inc

  • Neurological Surgery Physician
  • Jacksonville, FL
  • NPI 1417987124
  Medicare reassignment NPD
• Thrive Medical Partners LLC

  • Pain Medicine Physician
  • Gainesville, GA
  • NPI 1144707001
  Medicare reassignment NPD
• Back T0 Balance Health and Wellness

  dba Pivotal Pain Solutions

  • Physician Assistant
  • Alpharetta, GA
  • NPI 1417844853
  Medicare reassignment
• Stevens Family Chiropractic, PC

  dba Woodstock Health Institute

  • Chiropractor
  • Woodstock, GA
  • NPI 1629602784
  Medicare reassignment
• Thrive Orthopaedics LLC

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1790386258
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1073009619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746647",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746647",
            "telephone_number": "904-388-6518",
            "fax_number": "904-384-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14546 OLD SAINT AUGUSTINE RD STE 409",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585473",
            "telephone_number": "904-388-6518",
            "fax_number": "904-384-1005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Shircliff Way Ste 714",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322044786",
            "country_code": "US",
            "telephone_number": "904-308-2006",
            "fax_number": "904-308-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DYAL",
        "first_name": "TIFFANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-06",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111506",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9111506",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dwight W. Jones, D.M.D., P.a.
• Brandon Dwyer, RBT
• Patrick J Dwyer, MD
• Allison Dyal, LMHC
• Savannah Dyal
• Laura Holliday Dyar, MS, CCC-SLP
• Karlene Dyce, RCSWI
• Alexander Dye, MD
• Kenneth Dye, PA
• Mary Elizabeth Dye, MD

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.