Provider Demographics
NPI:1629419718
Name:MORALES, TIFFANY RAE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RAE
Last Name:MORALES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:RAE
Other - Last Name:ROBENOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-8885
Mailing Address - Fax:330-543-8890
Practice Address - Street 1:8423 MARKET ST STE 300
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6778
Practice Address - Country:US
Practice Address - Phone:330-543-8885
Practice Address - Fax:330-543-8890
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14856-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner