| Doctor Name: | TIFFANY VINSON |
| NPI Number: | 1336522648 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 4301108149 |
| Business Practice Address: | 24911 Little Mack Ave Suite C Saint Clair Shores, MI - 480803200 |
| Business Phone Number: | 5867772050 |
| Business Fax Number: | |
| Mailing Address: | 5151 Riverside Dr E, Apt 1102 WINDSOR |
| State: | ONTARIO |
| Postal Code: | N8S4R5 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2015 |
| NPI Last Update Date: | 07/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 4301108149 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |