Provider Demographics
NPI:1790511947
Name:CALVIN, TIFFANIE M
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:M
Last Name:CALVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10814 PURDY RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-9137
Mailing Address - Country:US
Mailing Address - Phone:513-900-0005
Mailing Address - Fax:
Practice Address - Street 1:10814 PURDY RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-9137
Practice Address - Country:US
Practice Address - Phone:513-900-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty