Provider Demographics
NPI:1447878566
Name:HORNBECK, TIFFANY (DNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HORNBECK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631671
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1671
Mailing Address - Country:US
Mailing Address - Phone:877-227-8823
Mailing Address - Fax:313-578-6393
Practice Address - Street 1:1411 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5480
Practice Address - Country:US
Practice Address - Phone:800-451-0481
Practice Address - Fax:810-985-5543
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner