Provider Demographics
NPI:1902091705
Name:BROWN, TIFFANY CHARISSE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:CHARISSE
Last Name:BROWN
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 1:2136 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1601
Mailing Address - Country:US
Mailing Address - Phone:216-481-4565
Mailing Address - Fax:
Practice Address - Street 1:2136 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44143-1601
Practice Address - Country:US
Practice Address - Phone:216-481-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH099673164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse