Provider Demographics
NPI:1952522310
Name:MAXWELL, TIFFANY SIMS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:SIMS
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:PSC 557 BOX 2324
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379
Mailing Address - Country:JP
Mailing Address - Phone:904-236-6691
Mailing Address - Fax:
Practice Address - Street 1:U.S. NAVAL HOSPTIAL OKINAWA
Practice Address - Street 2:PSC 482
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96362
Practice Address - Country:JP
Practice Address - Phone:643-7517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCPA030419363AM0700X
VA0110002210363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical