Healthcare Provider Details

I. General information

NPI: 1790637429
Provider Name (Legal Business Name): TIFFANY SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W 9TH ST
PANA IL
62557-1796
US

IV. Provider business mailing address

852 E 1000 NORTH RD
TOWER HILL IL
62571-4051
US

V. Phone/Fax

Practice location:
  • Phone: 217-562-1510
  • Fax:
Mailing address:
  • Phone: 217-565-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: