Provider Demographics
NPI:1629320189
Name:PARKER, TIFFANY (PA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PARKER
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 1:800 W. ELLIOT ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233
Mailing Address - Country:US
Mailing Address - Phone:480-545-2787
Mailing Address - Fax:484-545-1434
Practice Address - Street 1:800 W. ELLIOT ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233
Practice Address - Country:US
Practice Address - Phone:480-545-2787
Practice Address - Fax:484-545-1434
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant