Healthcare Provider Details

I. General information

NPI: 1952257289
Provider Name (Legal Business Name): DR. TIFFANY MICHELLE CAMPOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 S ASHLAND AVE
CHICAGO IL
60608-2014
US

IV. Provider business mailing address

1713 S ASHLAND AVE
CHICAGO IL
60608-2014
US

V. Phone/Fax

Practice location:
  • Phone: 312-742-1978
  • Fax:
Mailing address:
  • Phone: 312-742-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041467673
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: