Provider Demographics
NPI:1336677061
Name:KOSS, TIFFANY SUE (CRNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SUE
Last Name:KOSS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 HAYMAKER RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3516
Mailing Address - Country:US
Mailing Address - Phone:412-856-7740
Mailing Address - Fax:412-457-0392
Practice Address - Street 1:2626 HAYMAKER RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3516
Practice Address - Country:US
Practice Address - Phone:412-856-7740
Practice Address - Fax:412-457-0392
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily