Individual
TIFFANY L HAYNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5801
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5801
STATE LICENSE NUMBER
AZ
Enumeration date
10/24/2014
Last updated
07/15/2020
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