Provider Demographics
NPI:1447673975
Name:GANN, TIFFANY (PA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GANN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PERCY LN
Mailing Address - Street 2:
Mailing Address - City:MAYODAN
Mailing Address - State:NC
Mailing Address - Zip Code:27027-8263
Mailing Address - Country:US
Mailing Address - Phone:336-344-3756
Mailing Address - Fax:
Practice Address - Street 1:519 S VAN BUREN RD
Practice Address - Street 2:SUITE C
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5070
Practice Address - Country:US
Practice Address - Phone:336-627-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant