Provider Demographics
NPI:1639176753
Name:HARRIS, TIFFANY L (CNM)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:L
Other - Last Name:WELLS - HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1729 27TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2638
Practice Address - Country:US
Practice Address - Phone:740-354-1434
Practice Address - Fax:740-356-1261
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM07983176B00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100084750Medicaid
OH2621676Medicaid
OH2621676Medicaid