Provider Demographics
NPI:1558560680
Name:YOUTZY, TIFFANY (CRNA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:YOUTZY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1317 CRIMSON KING CT
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-8647
Mailing Address - Country:US
Mailing Address - Phone:309-945-7095
Mailing Address - Fax:
Practice Address - Street 1:1454 N COUNTY ROAD 2050 E
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-3551
Practice Address - Country:US
Practice Address - Phone:217-357-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-345516163W00000X
KS14-95155-031163W00000X
MO2003017943163W00000X
KS55615367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse