Healthcare Provider Details

I. General information

NPI: 1851416622
Provider Name (Legal Business Name): TIFFANY A. TASKAYA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY A. GEAHIGAN PA-C

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 UNIVERSITY DR STE B
DURHAM NC
27707-2654
US

IV. Provider business mailing address

636 MOUNTAIN PINE DR
CARY NC
27519-9616
US

V. Phone/Fax

Practice location:
  • Phone: 919-752-4028
  • Fax:
Mailing address:
  • Phone: 617-823-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1125
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08285
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: