Healthcare Provider Details

I. General information

NPI: 1346936549
Provider Name (Legal Business Name): TIFFANY BROOKE WARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 SOUTHWESTERN RUN
YOUNGSTOWN OH
44514-3688
US

IV. Provider business mailing address

135 CLINGAN ST
HUBBARD OH
44425-2023
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-0059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0033545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: