MEDICARE: TIFFANI ROSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP2201X	Ambulatory Care Registered Nurse	246407	SC

General Provider Information

NPI Number	:	1073457156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANI ROSS

Provider Business Mailing Address
First Line	:	444 BUCKHANNON LN
Second Line	:
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-6492
Country	:	US
Telephone Number	:	330-232-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 COURTENAY DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8911
Country	:	US
Telephone Number	:	854-276-7865
Fax Number	:	843-985-9382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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Directions to “ TIFFANI ROSS ” Practice Location

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