Provider Demographics
NPI:1669655387
Name:TOBIN, TIFFANI DAWN (PA)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:DAWN
Last Name:TOBIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E CAMPUS VIEW BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4682
Mailing Address - Country:US
Mailing Address - Phone:614-344-7547
Mailing Address - Fax:614-344-7547
Practice Address - Street 1:100 E CAMPUS VIEW BLVD STE 250
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4682
Practice Address - Country:US
Practice Address - Phone:614-344-7547
Practice Address - Fax:614-344-7547
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002715363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.002715OtherOHIO LIC