Provider Demographics
NPI:1699373696
Name:RICHMOND, TIFFONIE LYNN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:TIFFONIE
Middle Name:LYNN
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MRS
Other - First Name:TIFFONIE
Other - Middle Name:LYNN
Other - Last Name:CAUDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPHNP
Mailing Address - Street 1:3615 SOCIALVILLE FOSTERS RD. SUITE C
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-204-1910
Mailing Address - Fax:513-549-1556
Practice Address - Street 1:3615 SOCIALVILLE FOSTERS RD. SUITE C
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-204-1910
Practice Address - Fax:513-549-1556
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0027732363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner