Provider Demographics
NPI:1376283960
Name:YANG, TIFFANY-POLYNNE T (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY-POLYNNE
Middle Name:T
Last Name:YANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:STAPORNKUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 CARMICHAEL WAY STE 606
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2489
Mailing Address - Country:US
Mailing Address - Phone:757-401-4163
Mailing Address - Fax:757-908-2065
Practice Address - Street 1:200 CARMICHAEL WAY STE 606
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-2489
Practice Address - Country:US
Practice Address - Phone:757-401-4163
Practice Address - Fax:757-908-2065
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical