Provider Demographics
NPI:1134918469
Name:ABBOTT, TIFFANY DAWN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DAWN
Last Name:ABBOTT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54915 PUGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALLEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:43902-9724
Mailing Address - Country:US
Mailing Address - Phone:740-213-3495
Mailing Address - Fax:
Practice Address - Street 1:54915 PUGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:ALLEDONIA
Practice Address - State:OH
Practice Address - Zip Code:43902-9724
Practice Address - Country:US
Practice Address - Phone:740-213-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty