Provider Demographics
NPI:1124617675
Name:JAROSZ, TIFFANY SUE
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:SUE
Last Name:JAROSZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23720 LIME CITY RD LOT 54
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9582
Mailing Address - Country:US
Mailing Address - Phone:419-708-6941
Mailing Address - Fax:
Practice Address - Street 1:23720 LIME CITY RD LOT 54
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-9582
Practice Address - Country:US
Practice Address - Phone:419-708-6941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child