Healthcare Provider Details

I. General information

NPI: 1780434043
Provider Name (Legal Business Name): TIFFANY ROZANSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST
DOVER DE
19904-3485
US

IV. Provider business mailing address

110 GREEN FOREST DR
MIDDLETOWN DE
19709-1764
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-0223
  • Fax:
Mailing address:
  • Phone: 302-528-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0012684
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: