Provider Demographics
NPI:1962726943
Name:CARDINAL, TIFFANY M (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9951 MICKELBERRY RD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8309
Mailing Address - Country:US
Mailing Address - Phone:360-692-9362
Mailing Address - Fax:360-692-6214
Practice Address - Street 1:9951 MICKELBERRY RD NW STE 101
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8309
Practice Address - Country:US
Practice Address - Phone:360-692-9362
Practice Address - Fax:360-692-6214
Is Sole Proprietor?:No
Enumeration Date:2010-03-20
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017027471208000000X
WA60343447208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics