Provider Demographics
NPI:1427646215
Name:BLOOMFIELD, TIFFANY LEEANN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEEANN
Last Name:BLOOMFIELD
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 1:5521 INDIAN HILL RD SE
Mailing Address - Street 2:
Mailing Address - City:UHRICHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44683-1327
Mailing Address - Country:US
Mailing Address - Phone:330-204-8346
Mailing Address - Fax:
Practice Address - Street 1:5521 INDIAN HILL RD SE
Practice Address - Street 2:
Practice Address - City:UHRICHSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44683-1327
Practice Address - Country:US
Practice Address - Phone:330-204-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7901623Medicaid