| NPI | 1750557062 |
|---|---|
| Former Name | TIFFANY NICOLE MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1127) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY PA1127) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2009-10-27 |