Provider Demographics
NPI:1891570222
Name:HOGAN, TIFFANY R (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:R
Last Name:HOGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9162 GRANVILLE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2042
Mailing Address - Country:US
Mailing Address - Phone:317-992-3236
Mailing Address - Fax:
Practice Address - Street 1:2921 E 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-2411
Practice Address - Country:US
Practice Address - Phone:317-992-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28261081A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse