Healthcare Provider Details

I. General information

NPI: 1558624130
Provider Name (Legal Business Name): TIFFANY ELIZABETH BORSARI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 COMMERCIAL ST
MASHPEE MA
02649-6507
US

IV. Provider business mailing address

82 FALES RD
BRISTOL RI
02809-1608
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-7090
  • Fax:
Mailing address:
  • Phone: 413-374-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4905
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: