Provider Demographics
NPI:1801830708
Name:NOONAN, TIFFANIE D (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:D
Last Name:NOONAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:D
Other - Last Name:MICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1661
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29457-1661
Mailing Address - Country:US
Mailing Address - Phone:843-920-0046
Mailing Address - Fax:844-339-9220
Practice Address - Street 1:3227 WALTER DR STE C1
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-8171
Practice Address - Country:US
Practice Address - Phone:843-920-0046
Practice Address - Fax:843-920-0001
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9813208000000X
SC83446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics