| NPI | 1972667061 |
|---|---|
| Former Name | TIFFANI NICOLE TAYLOR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05089) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0003904) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2019-08-26 |