Healthcare Provider Details

I. General information

NPI: 1174448773
Provider Name (Legal Business Name): TIFFANY NICOLE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 CARMILL DR SE
HARTVILLE OH
44632-8900
US

IV. Provider business mailing address

1205 SHADOWLAWN DR
RAVENNA OH
44266-3606
US

V. Phone/Fax

Practice location:
  • Phone: 330-541-0684
  • Fax:
Mailing address:
  • Phone: 330-541-0684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: