Tiffany L Fontaine, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2443-023 Issued in WI

Practice address

1185 Corporate Center Dr Ste 300
Oconomowoc, WI 53066-4887

Phone

(414) 771-6780

Fax

(414) 238-2424

NPI assigned

Jul 20, 2009

Last updated

Apr 6, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Shore Urology, S.C.

  • Urology Physician
  • Milwaukee, WI
  • NPI 1871782987
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1639309057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 W INNOVATION DR STE 200",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264851",
            "telephone_number": "414-771-6780",
            "fax_number": "414-238-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 CORPORATE CENTER DR STE 300",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664887",
            "telephone_number": "414-771-6780",
            "fax_number": "414-238-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTAINE",
        "first_name": "TIFFANY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-20",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2443-023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne L Felden, PSYCHOLOGIST
• Ashley Feldman, LPC
• Nicole Felkl, PTA
• Flex Care Chiropractic LLC
• Mark W Flick, DO
• Forefront Dermatology, S.C.
• Leia Ahava Fox
• Ashley L Frechette, LPC
• Bradley Fritz, DC
• Vanessa Fritz, D.C.

• Physician Assistant in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.