Provider Demographics
NPI:1649470360
Name:WOODS, TIFFANI N (CNA)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:N
Last Name:WOODS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-3857
Mailing Address - Country:US
Mailing Address - Phone:219-938-0232
Mailing Address - Fax:
Practice Address - Street 1:1225 GREENE ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-3857
Practice Address - Country:US
Practice Address - Phone:219-938-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN44030601758374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide