Provider Demographics
NPI:1558655787
Name:WHITTEN, TIFFANY YOLANDA
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:YOLANDA
Last Name:WHITTEN
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 1:38460 OAK HILL LN APT 203
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7641
Mailing Address - Country:US
Mailing Address - Phone:440-231-5119
Mailing Address - Fax:
Practice Address - Street 1:38460 OAK HILL LN APT 203
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7641
Practice Address - Country:US
Practice Address - Phone:440-231-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide