Provider Demographics
NPI:1841283041
Name:ROBINSON, TIFFANY SHEA (PA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHEA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 RING RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7998
Mailing Address - Country:US
Mailing Address - Phone:270-765-5926
Mailing Address - Fax:270-763-0051
Practice Address - Street 1:1311 RING RD STE 103
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8941
Practice Address - Country:US
Practice Address - Phone:270-986-7372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA713363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000310563OtherANTHEM BLUE CROSS
KYP00136548OtherMEDICARE-RAILROAD CARRIER
KYP56719Medicare UPIN
KYP00136548OtherMEDICARE-RAILROAD CARRIER