Tiffany Jack, HIS

Primary specialty

Hearing Instrument SpecialistTaxonomy code 237700000X

License

AS4900 Issued in FL

Practice address

1130 Bichara Blvd
Lady Lake, FL 32159-7716

Phone

(352) 750-4327

Fax

(352) 750-2410

NPI assigned

Sep 4, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1114352630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N COMMONS DR STE 200",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047940",
            "telephone_number": "630-303-5380",
            "fax_number": "630-303-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 BICHARA BLVD",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321597716",
            "telephone_number": "352-750-4327",
            "fax_number": "352-750-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "TIFFANY",
        "credential": "HIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-04",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "FL",
            "license": "AS4900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intercommunity Cancer Center - Lady Lake Campus LLC
• J. Michael Whitt DMD PA
• Mark David Jacobson, M.D.
• Hemwattie S Jaimangal, DO
• Jane Johansson, APRN
• John Cottam MD PA
• Johnny Gurgen DO PA

• Hearing Instrument Specialist in Lady Lake, FL
• Providers in Lady Lake, FL by specialty
• Hearing Instrument Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.