Healthcare Provider Details

I. General information

NPI: 1851934483
Provider Name (Legal Business Name): TIFFANEE FRANCES WAZNY-KOHL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COLUMBUS AVE
BAY CITY MI
48708-6831
US

IV. Provider business mailing address

1900 COLUMBUS AVE
BAY CITY MI
48708-6831
US

V. Phone/Fax

Practice location:
  • Phone: 989-894-6090
  • Fax:
Mailing address:
  • Phone: 989-894-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704223072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: