Provider Demographics
NPI:1073636411
Name:JONES, TIFFANY REA (RN BSN)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:REA
Last Name:JONES
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 PENDENT LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3472
Mailing Address - Country:US
Mailing Address - Phone:614-497-2968
Mailing Address - Fax:
Practice Address - Street 1:3580 PENDENT LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3472
Practice Address - Country:US
Practice Address - Phone:614-497-2968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN280121163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2165231Medicaid