Provider Demographics
NPI:1528549706
Name:MALLOY, TIFFANY N (APRN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:MALLOY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7875 MONTGOMERY RD SPC 1102
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4378
Mailing Address - Country:US
Mailing Address - Phone:513-686-3031
Mailing Address - Fax:513-686-3032
Practice Address - Street 1:221 E 4TH ST STE 250
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-4264
Practice Address - Country:US
Practice Address - Phone:513-992-4951
Practice Address - Fax:513-924-8418
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012525363LF0000X
VA0024186523363LF0000X
OHAPRN.CNP.025802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily