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General NPI Number Information
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NPI Number | 1629460183
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Entity Type | Individual
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Provider Name | TIFFANI LYNETTE DORN PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/20/2015
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 919 GLYN EVANS CT
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City | NEWARK
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State | OH
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Zip | 43055-1792
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Country | US
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Telephone | 740-405-5120
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Fax | 740-788-8268
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Provider Business Mailing Address
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Address Line | 919 GLYN EVANS CT
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City | NEWARK
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State | OH
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Zip | 43055-1792
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Country | US
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Telephone | 740-405-5120
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Fax | 740-788-8268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7562-23
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA006586
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.008370
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 027353
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004253
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License Number State | OH
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