Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 1809 | TN |
Y | 208600000X | Surgeon | 1809 | TN |
N | 208200000X | Surgeon | 3449 | WV |
N | 208600000X | Surgeon | 3449 | WV |
N | 2086S0102X | Surgical Critical Care | 3449 | WV |
N | 2086S0127X | Trauma Surgeon | 1809 | TN |
N | 2086S0127X | Trauma Surgeon | 5101014615 | MI |
NPI | 1104861731 |
---|---|
Provider Name | Tiffany M Lasky |
First Address | Mountain Home, TN 37684-0699 |
Second Address | Johnson City, TN 37604-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 07/08/2019 |