Provider Demographics
NPI:1104856079
Name:SERELL, TIFFANY ALAIRE (PA-C,MS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ALAIRE
Last Name:SERELL
Suffix:
Gender:F
Credentials:PA-C,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E ELIZABETH ST
Mailing Address - Street 2:SUITE G-2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4044
Mailing Address - Country:US
Mailing Address - Phone:970-484-6303
Mailing Address - Fax:970-484-6908
Practice Address - Street 1:1120 E ELIZABETH ST
Practice Address - Street 2:SUITE G-2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4044
Practice Address - Country:US
Practice Address - Phone:970-484-6303
Practice Address - Fax:970-484-6908
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA2112363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical