Healthcare Provider Details

I. General information

NPI: 1801421870
Provider Name (Legal Business Name): MACY TIATTI COLEMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACY TIATTI HEPA-CYR PA

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 84-336-6618
  • Fax: 808-433-1551
Mailing address:
  • Phone: 808-433-6661
  • Fax: 808-433-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1174419
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: