Provider Demographics
NPI:1225311921
Name:GREENE, TIFFANY M (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:GREENE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:107 ROYAL BIRKDALE DR STE D
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8493
Mailing Address - Country:US
Mailing Address - Phone:330-482-9371
Mailing Address - Fax:330-482-0941
Practice Address - Street 1:107 ROYAL BIRKDALE DR STE D
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8493
Practice Address - Country:US
Practice Address - Phone:330-482-0937
Practice Address - Fax:330-482-0941
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003400363AS0400X
OH50.003400RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067385Medicaid
OHH036160Medicare PIN