Provider Demographics
NPI:1639830441
Name:GALLIMORE, TIFFANI MICHELLE (APRN, CNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:MICHELLE
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:APRN, CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1504
Mailing Address - Country:US
Mailing Address - Phone:937-369-3234
Mailing Address - Fax:
Practice Address - Street 1:7901 SCHATZ POINTE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3824
Practice Address - Country:US
Practice Address - Phone:937-438-9841
Practice Address - Fax:937-438-9851
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030477363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health