Individual
TIFFANY PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
375 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1260
(801) 446-3038
Mailing address
375 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1260
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7677725-8906
UT
Other
Enumeration date
07/16/2019
Last updated
12/07/2020
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