Provider Demographics
NPI:1033847363
Name:MITCHELL, TIFFANY E (MS)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W OMAHA ST APT 1118
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0641
Mailing Address - Country:US
Mailing Address - Phone:918-706-9972
Mailing Address - Fax:
Practice Address - Street 1:2401 W OMAHA ST APT 1118
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-0641
Practice Address - Country:US
Practice Address - Phone:918-706-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator