Individual
TIFFANIE C. WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002881
CT
363A00000X
Physician Assistant
PA4425
MA
363AM0700X
Medical Physician Assistant
002881
CT
363AS0400X
Surgical Physician Assistant
Primary
002881
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003028818
—
CT
Enumeration date
09/06/2012
Last updated
02/17/2017
Update your record
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