Provider Demographics
NPI:1518240571
Name:BROWN, TIFFANY L (CNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 CORKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4904
Mailing Address - Country:US
Mailing Address - Phone:937-760-2035
Mailing Address - Fax:
Practice Address - Street 1:1715 INDIAN WOOD CIR STE 200
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4055
Practice Address - Country:US
Practice Address - Phone:877-564-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058393Medicaid
OH000000744488OtherBCBS OHIO
OHP01019993OtherRR MEDICARE
OH421534506184OtherCARESOURCE - OHIO
OH421534506184OtherCARESOURCE - OHIO
OHP01019993OtherRR MEDICARE