Healthcare Provider Details

I. General information

NPI: 1013280148
Provider Name (Legal Business Name): TIFFANY MARIE BECKER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MCCREIGHT AVE STE 211
SPRINGFIELD OH
45504-1853
US

IV. Provider business mailing address

2379 GERARD CT
FAIRBORN OH
45324-2296
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-3696
  • Fax:
Mailing address:
  • Phone: 937-546-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0033831
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: