Provider Demographics
NPI:1629460183
Name:DORN, TIFFANI LYNETTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:LYNETTE
Last Name:DORN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 GLYN EVANS CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1792
Mailing Address - Country:US
Mailing Address - Phone:740-405-5120
Mailing Address - Fax:740-788-8268
Practice Address - Street 1:919 GLYN EVANS CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1792
Practice Address - Country:US
Practice Address - Phone:740-405-5120
Practice Address - Fax:740-788-8268
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7562-23363A00000X
PAOA006586363A00000X
IL085.008370363A00000X
NY027353363A00000X
OH004253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant