Provider Demographics
NPI:1568773422
Name:COX, TIFFANY ROSE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ROSE
Last Name:COX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SW COLUMBIA ST STE 6210
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1099
Mailing Address - Country:US
Mailing Address - Phone:541-383-3005
Mailing Address - Fax:
Practice Address - Street 1:1250 SW VETERANS WAY STE 1200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2585
Practice Address - Country:US
Practice Address - Phone:541-923-4462
Practice Address - Fax:541-383-1883
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60393342363LF0000X
OR201050091NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500623967OtherDHS
ORR156191Medicare Oscar/Certification