Provider Demographics
NPI:1023335106
Name:LANCE, TIFFANY DEANNA (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DEANNA
Last Name:LANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DEANNA
Other - Last Name:MAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:410 N CEDAR BLUFF RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3623
Mailing Address - Country:US
Mailing Address - Phone:865-342-8900
Mailing Address - Fax:865-691-0843
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:SUPPORT TOWER 3RD FLOOR
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-1435
Practice Address - Fax:864-455-1320
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL32817208600000X
TNMD0000051185207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery