Provider Demographics
NPI:1295738565
Name:KIRSCH, TIFFANNY BROOKE (NP)
Entity type:Individual
Prefix:
First Name:TIFFANNY
Middle Name:BROOKE
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 GLENWAY AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6375
Mailing Address - Country:US
Mailing Address - Phone:513-922-6666
Mailing Address - Fax:513-922-1812
Practice Address - Street 1:7777 UNIVERSITY CT
Practice Address - Street 2:APT C
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6563
Practice Address - Country:US
Practice Address - Phone:513-922-6666
Practice Address - Fax:513-922-1812
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07005363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2382023Medicaid
OHP23044Medicare UPIN
OH2382023Medicaid