Provider Demographics
NPI:1235875808
Name:RICHARDSON, TIFFANIE JACQUESS (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:JACQUESS
Last Name:RICHARDSON
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 1:1381 ORLANDO CIR NE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-6501
Mailing Address - Country:US
Mailing Address - Phone:205-915-0824
Mailing Address - Fax:
Practice Address - Street 1:599 FARMINGTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2356
Practice Address - Country:US
Practice Address - Phone:860-837-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical