Provider Demographics
NPI:1215755830
Name:AUSTIN, TIFFANIE VALERIE (LPN)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:VALERIE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26387 BRUSH AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3215
Mailing Address - Country:US
Mailing Address - Phone:440-376-7713
Mailing Address - Fax:
Practice Address - Street 1:26387 BRUSH AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3215
Practice Address - Country:US
Practice Address - Phone:440-376-7713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH188831164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse