1124082227 NPI number — MS. TIFFANY J TROXEL PAC

Table of content: MS. TIFFANY J TROXEL PAC (NPI 1124082227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124082227 NPI number — MS. TIFFANY J TROXEL PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROXEL
Provider First Name:
TIFFANY
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124082227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8838
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96931-8838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-647-5355
Provider Business Mailing Address Fax Number:
671-647-5358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 ROUTE 4
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SINAJANA
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96910-3368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-649-7232
Provider Business Practice Location Address Fax Number:
671-649-7233
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA-71 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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