Provider Demographics
NPI:1144581554
Name:CARLSON, TIFFANY (DO)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MISSION RANCH BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-5137
Mailing Address - Country:US
Mailing Address - Phone:530-894-0500
Mailing Address - Fax:
Practice Address - Street 1:114 MISSION RANCH BLVD STE 10
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5137
Practice Address - Country:US
Practice Address - Phone:530-894-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine