Provider Demographics
NPI:1538332747
Name:KUEBLER, TIFFANY HEIN (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:HEIN
Last Name:KUEBLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DENA
Other - Last Name:HEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:22 SOUTH GREENE ST
Mailing Address - Street 2:R ADAMS COWLEY SHOCK TRAUMA CENTER
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-328-7056
Mailing Address - Fax:410-328-8953
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:R ADAMS COWLEY SHOCK TRAUMA CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-8976
Practice Address - Fax:410-328-8953
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant