Provider Demographics
NPI:1639483670
Name:HANNIGAN, TIFFANY MICAELA (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MICAELA
Last Name:HANNIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 SPRING ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3748
Mailing Address - Country:US
Mailing Address - Phone:812-288-9646
Mailing Address - Fax:812-283-8391
Practice Address - Street 1:1407 SPRING ST
Practice Address - Street 2:CUITE 2
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3748
Practice Address - Country:US
Practice Address - Phone:812-288-9646
Practice Address - Fax:812-283-8391
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068589A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology