Healthcare Provider Details

I. General information

NPI: 1073457156
Provider Name (Legal Business Name): TIFFANI ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COURTENAY DR
CHARLESTON SC
29425-8911
US

IV. Provider business mailing address

444 BUCKHANNON LN
MONCKS CORNER SC
29461-6492
US

V. Phone/Fax

Practice location:
  • Phone: 854-276-7865
  • Fax: 843-985-9382
Mailing address:
  • Phone: 330-232-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number246407
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: