Individual
TIFFANY FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1950 NW MYHRE RD FL 3, SILVERDALE, WA 98383-7662
(564) 240-4200
(564) 240-4299
Mailing address
1950 NW MYHRE RD FL 3, SILVERDALE, WA 98383-7662
(564) 240-4200
(564) 240-4299
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61263669
WA
363AM0700X
Medical Physician Assistant
9541054-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2211780
—
WA
Enumeration date
10/06/2015
Last updated
09/21/2022
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