Provider Demographics
NPI:1316538085
Name:COLLABORATIVE FIRST ASSISTING, LLC
Entity Type:Organization
Organization Name:COLLABORATIVE FIRST ASSISTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TIFFANY-HARROD
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:260-404-4905
Mailing Address - Street 1:PO BOX 2165
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-2165
Mailing Address - Country:US
Mailing Address - Phone:260-409-4905
Mailing Address - Fax:214-279-9499
Practice Address - Street 1:14636 SHAVE LAKE DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-1975
Practice Address - Country:US
Practice Address - Phone:260-409-4905
Practice Address - Fax:214-279-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty