Active NPI
Tiffany Lynne Matheny
- Pharmacist
- Ponte Vedra, FL
National Provider Identifier
1083004337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS52310
- Practice address
- 120 Marketside Ave
Ponte Vedra, FL 32081-0574 - Phone
- (904) 825-1913
- NPI assigned
- Jan 26, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS52310 | FL | Primary |
Addresses
Primary practice location
120 Marketside Ave
Ponte Vedra, FL 32081-0574
Mailing address
120 Marketside Ave
Ponte Vedra, FL 32081-0574
Phone (904) 825-1913
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS52310 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Publix Super Markets Inc | Past | Accepting new patients | |
| Publix Super Markets Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Winter Haven, FL
- NPI 1760356380
-
- Pharmacy
- Ponte Vedra, FL
- NPI 1891026399
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422230400000",
"number": "1083004337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 MARKETSIDE AVE",
"city": "PONTE VEDRA",
"state": "FL",
"postal_code": "320810574",
"telephone_number": "904-825-1913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 MARKETSIDE AVE",
"city": "PONTE VEDRA",
"state": "FL",
"postal_code": "320810574",
"telephone_number": "904-825-1913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHENY",
"first_name": "TIFFANY",
"middle_name": "LYNNE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-26",
"last_updated": "2015-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS52310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ponte Vedra, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.