MEDICARE: TIFFANY COX ROMANELLO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9618	GA
2	363AS0400X	Surgical Physician Assistant	PA10338	TX
3	363A00000X	Physician Assistant	0010-05063	NC
4	207N00000X	Dermatology Physician	9618	GA

General Provider Information

NPI Number	:	1689088940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY COX ROMANELLO PA-C

Provider Business Mailing Address
First Line	:	112 WILSHIRE VILLAGE DR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3138
Country	:	US
Telephone Number	:	770-676-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 WILSHIRE VILLAGE DR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3138
Country	:	US
Telephone Number	:	770-676-3376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	04/08/2026

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