Provider Demographics
NPI:1144953001
Name:BURNETT, TIFFANY RITA-JANE (PA-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RITA-JANE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:RITA-JANE
Other - Last Name:LAMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:442 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-2927
Mailing Address - Country:US
Mailing Address - Phone:256-348-7667
Mailing Address - Fax:
Practice Address - Street 1:1537 FREEDOM WAY STE 2
Practice Address - Street 2:
Practice Address - City:HUBERT
Practice Address - State:NC
Practice Address - Zip Code:28539-3647
Practice Address - Country:US
Practice Address - Phone:910-238-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1213396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant