| NPI | 1922258821 |
|---|---|
| Former Name | TIFFANY GENET BURNSIDE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 19942) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA-C19942) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2022-01-04 |