Individual
MS. TIFFANY A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
404 W FOUNTAIN ST, ALBERT LEA, MN 56007-2437
(507) 373-2384
Mailing address
404 W FOUNTAIN ST, ALBERT LEA, MN 56007-2437
(507) 377-6285
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12149
MN
363A00000X
Physician Assistant
PA16777
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA16777
—
CA
Enumeration date
06/13/2006
Last updated
07/28/2020
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