MEDICARE: MISS TIFFANY SHANNON RAY CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	15099	TN
2	367500000X	Certified Registered Nurse Anesthetist	864509	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114097615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TIFFANY SHANNON RAY CRNA

Provider Business Mailing Address
First Line	:	PO BOX 381468
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-1468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 WALNUT GROVE RD
Second Line	:
City	:	HORN LAKE
State	:	MS
Zip	:	38637-2023
Country	:	US
Telephone Number	:	901-652-0880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	02/16/2026

Similar Medicare Providers

1821122854 — MS. LINDSAY BETH GASCH PHARM. D.
Practice Location Address:

1400 S 600 E
SALT LAKE CITY, UT
84105-2023

Practice Phone: 262-442-9282
Practice Fax:

1922209485 — MR. DOUGLAS J VINCENT LCSW
Practice Location Address:

2023 ROUTE 9
ROUND LAKE, NY
12151-1701

Practice Phone: 518-877-5301
Practice Fax: 518-877-5302

1649560640 — CAROL LEE WILLIAMS LCSW
Practice Location Address:

2023 ROUTE 9
ROUND LAKE, NY
12151-1701

Practice Phone: 518-406-3119
Practice Fax: 518-406-3119

1386048494 — OPEN DOORS COUNSELING
Practice Location Address:

2023 ROUTE 9 , USHERS PARK 9
ROUND LAKE, NY
12151-1701

Practice Phone: 518-406-3119
Practice Fax: 518-406-3119

1639564222 — CINDY ELIZABETH SANTAMARIA COTA
Practice Location Address:

908 POPLAR DR
LAKE PARK, FL
33403-2023

Practice Phone: 561-293-6074
Practice Fax:

1639627482 — LINDA SIMPSON
Practice Location Address:

54 MCGAW AVE
LAKE GROVE, NY
11755-2023

Practice Phone: 516-319-6977
Practice Fax:

Directions to “ MISS TIFFANY SHANNON RAY CRNA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.