Provider Demographics
NPI:1376297523
Name:CROSBY, TIFFANY TYNISHA
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TYNISHA
Last Name:CROSBY
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 1:963 PAXTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2460
Mailing Address - Country:US
Mailing Address - Phone:216-319-9911
Mailing Address - Fax:
Practice Address - Street 1:963 PAXTON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2460
Practice Address - Country:US
Practice Address - Phone:216-319-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide