| Doctor Name: | TIFFANI BOTTS |
| NPI Number: | 1316327877 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA 9108711 |
| Business Practice Address: | 411 W Saint Charles Rd Villa Park, IL - 601812432 |
| Business Phone Number: | 6306911234 |
| Business Fax Number: | 6305660975 |
| Mailing Address: | 411 W Saint Charles Rd, VILLA PARK |
| State: | IL |
| Postal Code: | 601812432 |
| Phone Number: | |
| Fax Number: | 6305660975 |
| NPI Enumeration Date: | 05/31/2015 |
| NPI Last Update Date: | 08/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA 9108711 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |