Provider Demographics
NPI:1326509340
Name:SMITH, TIFFANY DARNICE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DARNICE
Last Name:SMITH
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 1:1114 BROOKVIEW DR APT 19
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7270
Mailing Address - Country:US
Mailing Address - Phone:419-509-0198
Mailing Address - Fax:
Practice Address - Street 1:1114 BROOKVIEW DR APT 19
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7270
Practice Address - Country:US
Practice Address - Phone:419-509-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651892376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide