Provider Demographics
NPI:1295500965
Name:MATHIAS, TIFFANY (LPN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MATHIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:48799 TOWNSHIP ROAD 15B
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-9363
Mailing Address - Country:US
Mailing Address - Phone:740-294-0013
Mailing Address - Fax:
Practice Address - Street 1:48799 TOWNSHIP ROAD 15B
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-9363
Practice Address - Country:US
Practice Address - Phone:174-029-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker