Provider Demographics
NPI:1245615160
Name:ROSS, TIFFANI (CMF)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17436 MIDNIGHT EXPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8180
Mailing Address - Country:US
Mailing Address - Phone:330-207-7099
Mailing Address - Fax:
Practice Address - Street 1:17436 MIDNIGHT EXPRESS WAY
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8180
Practice Address - Country:US
Practice Address - Phone:330-207-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC50985224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter