Healthcare Provider Details

I. General information

NPI: 1174984199
Provider Name (Legal Business Name): TIFFANY ROSS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N ROLLING RD STE 305
CATONSVILLE MD
21228-4142
US

IV. Provider business mailing address

516 N ROLLING RD STE 305
CATONSVILLE MD
21228-4142
US

V. Phone/Fax

Practice location:
  • Phone: 410-364-4994
  • Fax: 410-847-2327
Mailing address:
  • Phone: 410-364-4994
  • Fax: 410-847-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP500024495
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR170722
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: