Provider Demographics
NPI:1124992102
Name:ANDONIAN-BOLDEN, TIFFANY ANNETTE (RN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNETTE
Last Name:ANDONIAN-BOLDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 GLEN EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9501
Mailing Address - Country:US
Mailing Address - Phone:260-415-5575
Mailing Address - Fax:
Practice Address - Street 1:7440 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1720
Practice Address - Country:US
Practice Address - Phone:260-280-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28169783C163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse