Provider Demographics
NPI:1457600033
Name:ADAMS, TIFFANIE LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:LAUREN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 PARSIFAL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4304
Mailing Address - Country:US
Mailing Address - Phone:704-312-8474
Mailing Address - Fax:704-912-1744
Practice Address - Street 1:416 MCCULLOUGH DR STE 205
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4392
Practice Address - Country:US
Practice Address - Phone:704-312-8474
Practice Address - Fax:704-912-1744
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001003714363AM0700X
NC0010-03714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical