Individual
TIFFANY L LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
19 NORTH ST, PRESQUE ISLE, ME 04769-2240
(207) 768-4568
Mailing address
19 NORTH ST, PRESQUE ISLE, ME 04769-2240
(120) 776-8456
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1437
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801225800
—
ME
Enumeration date
11/11/2013
Last updated
04/02/2024
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