Provider Demographics
NPI:1942911565
Name:ASHWORTH, TIFFANY (RD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ASHWORTH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5262 DREW RUN
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1105
Mailing Address - Country:US
Mailing Address - Phone:256-612-8455
Mailing Address - Fax:
Practice Address - Street 1:5262 DREW RUN
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1105
Practice Address - Country:US
Practice Address - Phone:205-612-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5037133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered