Healthcare Provider Details

I. General information

NPI: 1245623347
Provider Name (Legal Business Name): TIFFANY OWENS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY MCCLUNG RN

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 COLUMBUS AVE
LEBANON OH
45036-8258
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 513-282-3010
  • Fax:
Mailing address:
  • Phone: 615-425-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.16710-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: