Provider Demographics
NPI:1790925345
Name:CARD, TIFFANY ELIZABETH (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ELIZABETH
Last Name:CARD
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ELIZABETH
Other - Last Name:GARNSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3925 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1738
Mailing Address - Country:US
Mailing Address - Phone:716-250-9999
Mailing Address - Fax:716-250-6555
Practice Address - Street 1:3925 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1738
Practice Address - Country:US
Practice Address - Phone:716-250-9999
Practice Address - Fax:716-250-6555
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013168363A00000X
WI3064-23363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03319055Medicaid
NY03319055Medicaid