Provider Demographics
NPI:1427562487
Name:MCCABE, TIFFANY RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RAE
Last Name:MCCABE
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 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:1600 7TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2288
Practice Address - Country:US
Practice Address - Phone:206-267-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6991363A00000X, 363AM0700X, 363AS0400X
WAPA60828342363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1146616OtherNCCPA PHYSICIAN ASSISTANT CERTIFIED
AZ6991OtherLICENSED PHYSICIAN ASSISTANT- ARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS
WAPA60828342OtherLICENSED PHYSICIAN ASSISTANT- WASHINGTON DEPARTMENT OF HEALTH