Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tiffany Wisham

Individual provider Behavior Technician · NPI 1003561622

Tiffany Wisham is a Behavior Technician in Jacksonville, Florida. Registered with an NPI since 2022.

In the registry since
2022

Practice location Address checks out

12724 Gran Bay Pkwy W Ste 410
Jacksonville, FL 32258-9486
Phone: (855) 832-6727
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X

Record details

NPI number1003561622
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 14, 2022
Last updated in NPPESSeptember 28, 2025
Certification dateSeptember 28, 2025
Mailing address300 International Pkwy Ste 200, Lake Mary, FL 32746-5028

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