Tiffany B. Moreland, LSA, CSFA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

SA00639 Issued in TX

Practice address

2007 Shasta Ridge Dr
Conroe, TX 77304-4697

Phone

(936) 444-7071

NPI assigned

Jun 22, 2011

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Eastlake Surgical Associates, LLC

  • Surgical Physician Assistant
  • Conroe, TX
  • NPI 1780163378
  NPD Authorized official

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1811283310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2007 SHASTA RIDGE DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044697",
            "telephone_number": "936-444-7071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2007 SHASTA RIDGE DR",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773044697",
            "telephone_number": "936-444-7071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17200 St Lukes Way",
            "address_purpose": "LOCATION",
            "city": "The Woodlands",
            "state": "TX",
            "postal_code": "773848007",
            "country_code": "US",
            "telephone_number": "936-444-7071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORELAND",
        "first_name": "TIFFANY",
        "middle_name": "B.",
        "name_prefix": "Mrs.",
        "credential": "LSA, CSFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "SA00639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Marie Moore, C.O.T.A.
• Tareah Moore
• Angelo Morales, RN
• Nancy Lucero Morataya, RN
• Lenny Nazareno Morejon Garzon, OTR/L
• General Reno Morelock
• Crystal Moreno, RN
• Brandon Morgan, LPC INTERN
• Nicholas Shepherd Morgan
• Amit Mori, M.D.

• Surgical Physician Assistant in Conroe, TX
• Providers in Conroe, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.