Provider Demographics
NPI:1952780496
Name:TIFFANY-HARROD, LAURA ROSALIE (CSFA, LSA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ROSALIE
Last Name:TIFFANY-HARROD
Suffix:
Gender:F
Credentials:CSFA, LSA
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Mailing Address - Street 1:PO BOX 2165
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262
Mailing Address - Country:US
Mailing Address - Phone:260-409-4905
Mailing Address - Fax:214-279-9499
Practice Address - Street 1:14636 SHAVE LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:260-409-4905
Practice Address - Fax:469-702-2663
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2021-02-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical