Provider Demographics
NPI:1487920971
Name:DEPRIEST, TIFFANY LEA ANN
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LEA ANN
Last Name:DEPRIEST
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 1:4800 STATE ROUTE 522
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-8962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6405 ST. RT. 522
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645
Practice Address - Country:US
Practice Address - Phone:740-533-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH124619164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse