Healthcare Provider Details

I. General information

NPI: 1750084778
Provider Name (Legal Business Name): TIFFANY ANNE DUTTKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY ANNE BUESKING

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16012 REMORA BLVD
BROOKPARK OH
44142-2218
US

IV. Provider business mailing address

16012 REMORA BLVD
BROOKPARK OH
44142-2218
US

V. Phone/Fax

Practice location:
  • Phone: 216-704-0699
  • Fax:
Mailing address:
  • Phone: 216-704-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License NumberDT.006427
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 9
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: