Provider Demographics
NPI:1891420352
Name:COX, TIFFANY DIANE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DIANE
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8054 LITTLE CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1074
Mailing Address - Country:US
Mailing Address - Phone:330-219-6286
Mailing Address - Fax:
Practice Address - Street 1:8440 WOODFIELD CROSSING BLVD STE 175
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4359
Practice Address - Country:US
Practice Address - Phone:317-803-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001720A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered