Healthcare Provider Details

I. General information

NPI: 1336677061
Provider Name (Legal Business Name): TIFFANY SUE KOSS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 HAYMAKER RD
MONROEVILLE PA
15146-3516
US

IV. Provider business mailing address

160 HOLLYWOOD DR
BUTLER PA
16001-5600
US

V. Phone/Fax

Practice location:
  • Phone: 412-856-7740
  • Fax: 412-457-0392
Mailing address:
  • Phone: 724-282-6175
  • Fax: 724-482-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP017545
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: