Individual provider Active NPI

Tiffany Martin, APRN

  • Pediatric Nurse Practitioner
  • Tampa, FL
National Provider Identifier
1245967389
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
11020622 Issued in FL
Practice address
508 S Habana Ave Ste 340
Tampa, FL 33609-4191
Phone
(813) 873-7367
Fax
(813) 875-9722
NPI assigned
Aug 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 11020622 FL Primary

Addresses

Primary practice location

508 S Habana Ave Ste 340
Tampa, FL 33609-4191

Mailing address

508 S Habana Ave Ste 340
Tampa, FL 33609-4191
Phone (813) 873-7367

Other practice location 1

2 Tampa General Cir
Tampa, FL 33606-3571
Phone (813) 821-8038

Other identifiers 2

IdentifierTypeStateIssuer
115162200MedicaidFL
UAE19OtherFLBLUE CROSS BLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tmartin336127@direct.tgh.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20241031001702 FL Practitioner - Nurse Practitioner 5193258929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Florida College of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

13330 Usf Laurel Dr
Tampa, FL 33612-6601

17 Davis Blvd
Tampa, FL 33606-3475
Phone (813) 821-8038

4202 E Fowler Ave
Tampa, FL 33620-6750

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11020622FLMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Service Association Inc Current Accepting new patients
Tampa General Hospital Current Accepting new patients
University Medical Service Association Inc CurrentSince Oct 21, 2024 Accepting new patients
University Medical Service Association Inc CurrentSince Oct 21, 2024 Accepting new patients
Pediatric Epilepsy and Neurology Specialists PastSince Aug 14, 2022 Accepting new patients
University Medical Service Association Inc Past Accepting new patients

Locations

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

4202 E Fowler Ave
Stop SHS100
Tampa, FL 33620
Phone (813) 974-2331

17 Davis Blvd
Tampa, FL 33606
Phone (813) 250-2506

2 Tampa General Cir
Tampa, FL 33606
Phone (813) 259-8500

Interoperability endpoints

  • Direct secure messaging: tmartin336127@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 6

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1659916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1245967389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 S HABANA AVE STE 340",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094191",
            "telephone_number": "813-873-7367",
            "fax_number": "813-875-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 S HABANA AVE STE 340",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094191",
            "telephone_number": "813-873-7367",
            "fax_number": "813-875-9722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Tampa General Cir",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336063571",
            "country_code": "US",
            "telephone_number": "813-821-8038",
            "fax_number": "813-974-0483",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "TIFFANY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-08",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "11020622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115162200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "UAE19",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmartin336127@direct.tgh.org",
            "affiliation": "N",
            "address_1": "2 Tampa General Cir",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336063571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.