Provider Demographics
NPI:1609423532
Name:COLQUITT, TIFFANY JEANNETTE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JEANNETTE
Last Name:COLQUITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:JEANNETTE
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 W LONG ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2815
Mailing Address - Country:US
Mailing Address - Phone:614-225-0990
Mailing Address - Fax:614-225-0991
Practice Address - Street 1:16 W LONG ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2815
Practice Address - Country:US
Practice Address - Phone:614-225-0990
Practice Address - Fax:614-225-0991
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator