Provider Demographics
NPI:1083203665
Name:COLSTON, TIFFANY M (MSN, APRN, CNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:COLSTON
Suffix:
Gender:
Credentials:MSN, APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-1534
Mailing Address - Country:US
Mailing Address - Phone:419-707-0892
Mailing Address - Fax:
Practice Address - Street 1:6789 RIDGE RD STE 305
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5635
Practice Address - Country:US
Practice Address - Phone:888-880-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00035116363LA2200X
OHAPRN.CNP.0028286363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health