Provider Demographics
NPI:1760916415
Name:WORKMAN, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHAGELUK
Mailing Address - State:AK
Mailing Address - Zip Code:99665
Mailing Address - Country:US
Mailing Address - Phone:907-473-8231
Mailing Address - Fax:907-473-8213
Practice Address - Street 1:101 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHAGELUK
Practice Address - State:AK
Practice Address - Zip Code:99665
Practice Address - Country:US
Practice Address - Phone:907-473-8231
Practice Address - Fax:907-473-8213
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker