| NPI | 1720441355 |
|---|---|
| Former Name | TIFFANY BROOKE EDWARDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MS PA00374) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA058228) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2018-11-05 |