Provider Demographics
NPI:1669814885
Name:POTEET, TIFFANY DAWN (ACNP, BSN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:DAWN
Last Name:POTEET
Suffix:
Gender:F
Credentials:ACNP, BSN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DAWN
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-685-6567
Mailing Address - Fax:614-293-7221
Practice Address - Street 1:452 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-5502
Practice Address - Fax:614-293-4726
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.14313363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0135551Medicaid
OHH350690Medicare PIN