Healthcare Provider Details

I. General information

NPI: 1336641315
Provider Name (Legal Business Name): TIFFANY PITTMAN DMSC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 2ND ST W
PARK RAPIDS MN
56470-1506
US

IV. Provider business mailing address

1880 OFFICE CLUB PT STE 237
COLORADO SPRINGS CO
80920-5017
US

V. Phone/Fax

Practice location:
  • Phone: 320-500-2024
  • Fax: 320-244-7958
Mailing address:
  • Phone: 320-500-2024
  • Fax: 320-244-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: