Provider Demographics
NPI:1457751729
Name:JOHNSON, TIFFANY DIANE (STNA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DIANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 E 82ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-2944
Mailing Address - Country:US
Mailing Address - Phone:440-482-6220
Mailing Address - Fax:
Practice Address - Street 1:1406 E 82ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-2944
Practice Address - Country:US
Practice Address - Phone:440-650-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1457751729Medicaid