Clark, Tiffany A

Clark, Tiffany A is an individual health care provider with primary practice located at 404 W Fountain St , Albert Lea MN 56007-2437. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Clark, Tiffany A can be contacted via phone (507) 373-2384.

Contact Information

Primary practice address
404 W Fountain St Albert Lea MN 56007-2437
Phone: (507) 373-2384
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA16777 California
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 12149 Minnesota

Profile Details

NPI number 1831132406
LBN Legal business name Clark, Tiffany A
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Jul 28th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831132406 NPPES
California MEDICAID PA16777

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