Provider Demographics
NPI:1023206133
Name:MECKLER, TIFFANY NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:MECKLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 ROUTE 611 STE 300
Mailing Address - Street 2:
Mailing Address - City:BARTONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18321-7800
Mailing Address - Country:US
Mailing Address - Phone:272-212-3090
Mailing Address - Fax:866-289-8937
Practice Address - Street 1:3565 ROUTE 611 STE 300
Practice Address - Street 2:
Practice Address - City:BARTONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18321-7800
Practice Address - Country:US
Practice Address - Phone:272-212-3090
Practice Address - Fax:866-289-8937
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003992363A00000X
PAMA053215363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical