Healthcare Provider Details

I. General information

NPI: 1023206133
Provider Name (Legal Business Name): TIFFANY NICOLE MECKLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 ROUTE 611 STE 300
BARTONSVILLE PA
18321-7800
US

IV. Provider business mailing address

3565 ROUTE 611 STE 300
BARTONSVILLE PA
18321-7800
US

V. Phone/Fax

Practice location:
  • Phone: 272-212-3090
  • Fax: 866-289-8937
Mailing address:
  • Phone: 272-212-3090
  • Fax: 866-289-8937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003992
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053215
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: