Tiffany Jo Archer, PA-C
Individual provider Active NPI Physician Assistant · Gulfport, MS
NPI 1386896595 · NPPES record last updated Nov 7, 2024
Key facts
- NPI
- 1386896595
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 19896 (CA)
- Practice address
- 5501 Marvin Shields Blvd
Gulfport, MS 39501-9007 - Phone
- (228) 871-4033
- Fax
- (228) 871-3344
- NPI assigned
- Oct 21, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Western Un of HLTH Sciences, Col of Podiatric Med, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Inova Ucc LLC
Practice addresses (Care Compare)
20070 Ashbrook Commons PLZ
Unit 104
Ashburn, VA 20147-5035
Phone (571) 479-3116
6206 Rolling Rd
Springfield, VA 22152-2306
Phone (571) 889-3235
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA, DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160412000239 | VA | Practitioner - Physician Assistant | 8628133568 | Reassigns benefits to 1 organization |
| I20251104000085 | DC | Practitioner - Physician Assistant | 8628133568 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15-01691 | KS | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inova Ucc LLC | Current |
Accepting new patients | |
| Waikiki Health | Past | Accepting new patients |
Locations
20070 Ashbrook Commons Plz
Unit 104
Ashburn, VA 20147
Phone (571) 479-3116
43135 Broadlands Center Plz
Ste 123
Broadlands, VA 20148
Phone (571) 206-0742
24801 Pinebrook Rd
Ste 110
Chantilly, VA 20152
Phone (703) 722-2500
6206 Rolling Rd
Springfield, VA 22152
Phone (571) 889-3235
180 Maple Ave W
Vienna, VA 22180
Phone (703) 938-5300
Interoperability endpoints
- tarcher1465091@soc.inova.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 15-01691 | KS | |
| Physician Assistant | 363A00000X | 19896 | CA | Yes |
Addresses
Primary practice location
5501 Marvin Shields Blvd
Gulfport, MS 39501-9007
Mailing address
5016 Eagle Dr
Gulfport, MS 39501-3702
Phone (785) 215-1664
Other practice location 1
Hospital Americano, Base Naval de Rota
Apartado de Correos 33
Rota, Cadiz 11530
ES
Phone (785) 215-1664
Other providers in Gulfport, MS
- Callie Anglada
- Kristina Angus
- Anita Charlene Hall Aprn-BC LLC
- Julie Kersh Appel
- Anita Elizabeth Apperley
- Wesley Armstrong
- Jennifer Arocho
- Array of Hope
- Sanjuanita Arredondo
- Deannia Arrington
All providers in Gulfport, MS · Physician Assistant in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.