Healthcare Provider Details

I. General information

NPI: 1750208054
Provider Name (Legal Business Name): TIFFANY MATHUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W BANCROFT ST
TOLEDO OH
43606-3390
US

IV. Provider business mailing address

2801 W BANCROFT ST
TOLEDO OH
43606-3390
US

V. Phone/Fax

Practice location:
  • Phone: 800-586-5336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704312757
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042415
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: