Healthcare Provider Details

I. General information

NPI: 1508962242
Provider Name (Legal Business Name): TIFFANY JANE OWENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD FL 4
COLUMBUS OH
43212-3153
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-3687
  • Fax: 614-293-6176
Mailing address:
  • Phone: 614-366-3687
  • Fax: 614-293-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number35.091106
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57-012148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: