Healthcare Provider Details

I. General information

NPI: 1982172680
Provider Name (Legal Business Name): TIFFANY MARIE SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 WAYNESBURG DR SE
WAYNESBURG OH
44688-9789
US

IV. Provider business mailing address

6845 WAYNESBURG DR SE
WAYNESBURG OH
44688-9789
US

V. Phone/Fax

Practice location:
  • Phone: 330-413-3197
  • Fax:
Mailing address:
  • Phone: 330-413-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: