Provider Demographics
NPI:1518201474
Name:ANDERSON, TIFFANY RAE (MS PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 SOUTH DOWNING ST.
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210
Mailing Address - Country:US
Mailing Address - Phone:303-717-5193
Mailing Address - Fax:
Practice Address - Street 1:2525 SOUTH DOWNING ST.
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210
Practice Address - Country:US
Practice Address - Phone:303-717-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
COPA.0004143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant