Provider Demographics
NPI:1962783027
Name:MCDONALD-MARSH, TIFFANY MICHELLE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MICHELLE
Last Name:MCDONALD-MARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S COLORADO ST STE B
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-2707
Mailing Address - Country:US
Mailing Address - Phone:512-376-3377
Mailing Address - Fax:512-398-2007
Practice Address - Street 1:300 S COLORADO ST STE B
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2707
Practice Address - Country:US
Practice Address - Phone:512-376-3377
Practice Address - Fax:512-398-2007
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TXPA07444363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant