Provider Demographics
NPI:1790004356
Name:RAHN, TIFFANY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:RAHN
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 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5674
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL ORTHOPAEDIC SPECIALISTS
Practice Address - Street 2:1251-B RIBAUT RD
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6185
Practice Address - Country:US
Practice Address - Phone:843-524-3015
Practice Address - Fax:844-296-2306
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCPA2334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2235PAMedicaid
SCPA2334OtherSTATE LICENSE BOARD