Healthcare Provider Details

I. General information

NPI: 1831996297
Provider Name (Legal Business Name): TIFFANY TASHAW BOWLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 W 73RD AVE
MERRILLVILLE IN
46410-3814
US

IV. Provider business mailing address

990 W 73RD AVE
MERRILLVILLE IN
46410-3814
US

V. Phone/Fax

Practice location:
  • Phone: 219-613-3833
  • Fax:
Mailing address:
  • Phone: 219-613-3833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016717A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: