Provider Demographics
NPI:1093553323
Name:HERRON, TIFFANY (CNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S JUDKINS AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3140
Mailing Address - Country:US
Mailing Address - Phone:419-231-1409
Mailing Address - Fax:
Practice Address - Street 1:505 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-1868
Practice Address - Country:US
Practice Address - Phone:419-738-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0036571163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice