Provider Demographics
NPI:1740913920
Name:WILLIAMS, TIFFANY M (NURSING ASSISTANT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NURSING ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19380 NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1129
Mailing Address - Country:US
Mailing Address - Phone:216-762-3212
Mailing Address - Fax:
Practice Address - Street 1:19380 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1129
Practice Address - Country:US
Practice Address - Phone:216-762-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400836931108163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant