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General NPI Number Information
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NPI Number | 1780884809
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Entity Type | Individual
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Provider Name | TIFFANY FRAZIER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5000 W CHAMBERS ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-1650
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Country | US
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Telephone | 414-447-2171
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Fax | 414-858-2230
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Provider Business Mailing Address
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Address Line | 10625 W NORTH AVE STE 102
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City | MILWAUKEE
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State | WI
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Zip | 53226-2315
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Country | US
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Telephone | 414-877-5350
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Fax | 414-877-5360
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10751
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 1075102
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License Number State | WI
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