Healthcare Provider Details

I. General information

NPI: 1982445888
Provider Name (Legal Business Name): TIFFANY ROZELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W BROAD ST
COLUMBUS OH
43222-1465
US

IV. Provider business mailing address

2240 ABERDEEN AVE
COLUMBUS OH
43211-1810
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-0822
  • Fax:
Mailing address:
  • Phone: 614-208-7196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS005113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: