Provider Demographics
NPI:1851723894
Name:GARRISON, TIFFANY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:MARIE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:397 LITTLE NECK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5774
Mailing Address - Country:US
Mailing Address - Phone:757-395-1600
Mailing Address - Fax:757-961-9359
Practice Address - Street 1:397 LITTLE NECK RD STE 120
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5774
Practice Address - Country:US
Practice Address - Phone:757-395-1600
Practice Address - Fax:757-961-9359
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004446363AM0700X
GA363AM0700X
VA0110004446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2508OtherGEORGIA LICENSE
VA0110-004446OtherVIRGINIA LICENSURE