| Tiffany Dyal, | |
|
14546 Old Saint Augustine Rd Ste 409, Jacksonville, FL 32258-5473 | |
| (904) 388-6518 | |
| (904) 384-1005 |
| Full Name | Tiffany Dyal |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Location | 14546 Old Saint Augustine Rd Ste 409, Jacksonville, Florida |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073009619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | PA9111506 (Florida) | Primary |
| 363AS0400X | Physician Assistant - Surgical | PA9111506 (Florida) | Secondary |
| Entity Name | St Vincent's Ambulatory Care Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1417987124 PECOS PAC ID: 2860411188 Enrollment ID: O20051116000430 |
| Mailing Address | Practice Location Address |
|---|---|
| Tiffany Dyal, Po Box 746647, Atlanta, GA 30374-6647 Ph: (904) 388-6518 | Tiffany Dyal, 14546 Old Saint Augustine Rd Ste 409, Jacksonville, FL 32258-5473 Ph: (904) 388-6518 |
Katherine L Walsh, PA-C/MPH Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4500 San Pablo Rd S, Jacksonville, FL 32224 Phone: 904-953-2000 |
Teresa Louise Cowan, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1200 Riverplace Blvd, Suite 620, Jacksonville, FL 32207 Phone: 904-396-6620 Fax: 904-396-6528 |
Mrs. Melina Volner Sommese, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4500 San Pablo Rd S, Jacksonville, FL 32224 Phone: 904-953-2594 Fax: 904-953-6225 |
Mr. Thomas Matthew Mattox Jr., PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 15255 Max Leggett Pkwy Ste 5500, Jacksonville, FL 32218 Phone: 904-223-3321 |
Kyle Hollingsworth, PA-C, ATC Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 710 Lomax St, Jacksonville, FL 32204 Phone: 904-355-6583 |
Jessica Defazio, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 836 Prudential Dr Ste 1400, Jacksonville, FL 32207 Phone: 904-388-6518 Fax: 904-384-1005 |
Hangyu Shen Watson, M.D. Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4500 San Pablo Rd S, Jacksonville, FL 32224 Phone: 904-953-2000 |