Provider Demographics
NPI:1326549411
Name:PENN, TIFFANY NISHEE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NISHEE
Last Name:PENN
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 1:7162 READING RD STE 900
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-3879
Mailing Address - Country:US
Mailing Address - Phone:513-559-3184
Mailing Address - Fax:
Practice Address - Street 1:734 DAYTON ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3460
Practice Address - Country:US
Practice Address - Phone:513-737-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator