Provider Demographics
NPI:1669827929
Name:NEARY, TIFFANY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:NEARY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 HAVANA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3266
Mailing Address - Country:US
Mailing Address - Phone:303-307-2320
Mailing Address - Fax:
Practice Address - Street 1:3600 HAVANA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-3266
Practice Address - Country:US
Practice Address - Phone:303-307-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0004484363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical