Healthcare Provider Details

I. General information

NPI: 1083203665
Provider Name (Legal Business Name): TIFFANY M COLSTON MSN, APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6789 RIDGE RD STE 305
PARMA OH
44129-5635
US

IV. Provider business mailing address

415 E WATER ST
OAK HARBOR OH
43449-1534
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-3451
  • Fax:
Mailing address:
  • Phone: 419-707-0892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLE-00035116
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0028286
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: