Provider Demographics
NPI:1881091387
Name:EISENHAUER, TIFFANY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:EISENHAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:CHARLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:22 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2092
Mailing Address - Country:US
Mailing Address - Phone:207-406-7500
Mailing Address - Fax:207-618-5674
Practice Address - Street 1:22 STATION AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2092
Practice Address - Country:US
Practice Address - Phone:207-406-7500
Practice Address - Fax:207-618-5674
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2024-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1496363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical