Provider Demographics
NPI:1306343322
Name:WHIPPLE, TIFFANY PAULINE (DO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:PAULINE
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PAULI
Other - Middle Name:
Other - Last Name:WHIPPLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1215 HADLEY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-2907
Mailing Address - Country:US
Mailing Address - Phone:317-834-9618
Mailing Address - Fax:
Practice Address - Street 1:1215 HADLEY RD STE 201
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-2907
Practice Address - Country:US
Practice Address - Phone:317-834-9618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007024A208C00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKFW8619251OtherDEA