Healthcare Provider Details

I. General information

NPI: 1225632490
Provider Name (Legal Business Name): TIFFANY HOPE SIMMONS MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7484 SAVANNA DR
TEMPERANCE MI
48182-3005
US

IV. Provider business mailing address

7484 SAVANNA DR
TEMPERANCE MI
48182-3005
US

V. Phone/Fax

Practice location:
  • Phone: 419-509-3749
  • Fax:
Mailing address:
  • Phone: 419-509-3749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number532773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: