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General NPI Number Information
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NPI Number | 1639887185
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Entity Type | Individual
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Provider Name | TIFFANY JORDAN SMITH
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Gender | Female
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 23425 COMMERCE PARK STE 104
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City | BEACHWOOD
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State | OH
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Zip | 44122-5848
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Country | US
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Telephone | 216-831-2900
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Fax | 216-831-4306
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Provider Business Mailing Address
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Address Line | 1372 CARYL DR
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City | BEDFORD
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State | OH
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Zip | 44146
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Country | US
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Telephone | 419-217-2884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0035137
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 452706
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License Number State | OH
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