Provider Demographics
NPI:1083858757
Name:HARRIS, TIFFANY ANNA (NP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANNA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3491
Mailing Address - Country:US
Mailing Address - Phone:313-730-0070
Mailing Address - Fax:313-730-1672
Practice Address - Street 1:2845 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3491
Practice Address - Country:US
Practice Address - Phone:313-730-0070
Practice Address - Fax:313-730-1672
Is Sole Proprietor?:No
Enumeration Date:2009-04-26
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704228795363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics