Provider Demographics
NPI:1083373534
Name:ADKINS, TIFFANY AMBER
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AMBER
Last Name:ADKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 MORGAN CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9494
Mailing Address - Country:US
Mailing Address - Phone:740-612-7418
Mailing Address - Fax:
Practice Address - Street 1:1672 MORGAN CENTER RD
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9494
Practice Address - Country:US
Practice Address - Phone:740-612-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2700429253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH270049Medicaid