Provider Demographics
NPI:1265796148
Name:PALFINI, TIRA RENE (PA- C)
Entity type:Individual
Prefix:
First Name:TIRA
Middle Name:RENE
Last Name:PALFINI
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:TIRA
Other - Middle Name:RENE
Other - Last Name:WICKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-329-8596
Practice Address - Street 1:2350 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3455
Practice Address - Country:US
Practice Address - Phone:916-984-3899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant