Provider Demographics
NPI:1376552307
Name:MASAR, TIFFANI (PA)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:MASAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 NE 51ST TER
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-9610
Mailing Address - Country:US
Mailing Address - Phone:303-646-7501
Mailing Address - Fax:
Practice Address - Street 1:10250 SE 167TH PLACE RD UNIT 5
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8682
Practice Address - Country:US
Practice Address - Phone:352-307-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q29690Medicare UPIN