Individual
TIFFANIE C. WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
80 SEYMOUR STREET, HARTFORD HOSPITAL SURGERY DEPT, HARTFORD, CT 06102-5037
(860) 545-4670
Mailing address
MIMA, INC. - ATTN: PAM GREANEY, ONBOARD/CRED, 271 CAREW STREET, SPRINGFIELD, MA 01104-2377
(413) 748-6862
(413) 748-6863
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
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