MEDICARE: TIFFANY FORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1144856055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY FORD

Provider Business Mailing Address
First Line	:	1320 LEMANS CT APT 307
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 LEMANS CT APT 307
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1267
Country	:	US
Telephone Number	:	317-908-9004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	03/23/2020

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Directions to “ TIFFANY FORD ” Practice Location

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