Provider Demographics
NPI:1376084145
Name:O'CONNOR, TIFFANY B (PA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:B
Last Name:O'CONNOR
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Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:900 VILLAGE SQUARE XING
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4547
Mailing Address - Country:US
Mailing Address - Phone:561-627-8500
Mailing Address - Fax:561-627-2956
Practice Address - Street 1:900 VILLAGE SQUARE XING
Practice Address - Street 2:SUITE 170
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4547
Practice Address - Country:US
Practice Address - Phone:561-627-8500
Practice Address - Fax:561-627-2956
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-27
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Provider Licenses
StateLicense IDTaxonomies
FLPA9110230363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical