MEDICARE: TIFFANY D SWENSON PA-C

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	363AM0700X	Medical Physician Assistant	PAC0403	ND
2	363A00000X	Physician Assistant	PAC0403	ND
3	363A00000X	Physician Assistant	10357	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1053111	OTHER		PREFERRED ONE
2	PENDING	OTHER	MN	MN BCBS
3	30111	OTHER	ND	BCBS
4	HP84398	OTHER		HEALTH PARTNERS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0128334	OTHER		MEDICA

General Provider Information

NPI Number	:	1619164654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY D SWENSON PA-C

Provider Business Mailing Address
First Line	:	5257 27TH ST S STE 201
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-7782
Country	:	US
Telephone Number	:	701-356-5503
Fax Number	:

Provider Business Practice Location Address
First Line	:	5257 27TH ST S STE 201
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-7782
Country	:	US
Telephone Number	:	701-356-5503
Fax Number	:

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

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	04/28/2026

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Directions to “ TIFFANY D SWENSON PA-C” Practice Location

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