Provider Demographics
NPI:1518393040
Name:WILSON, TIFFANY MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:MARIE
Last Name:WILSON
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 1:1800 N MCCORD RD # P-172
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-8702
Mailing Address - Country:US
Mailing Address - Phone:419-514-9452
Mailing Address - Fax:
Practice Address - Street 1:1800 N MCCORD RD # P-172
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-8702
Practice Address - Country:US
Practice Address - Phone:419-514-9452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH529690163WF0300X, 163W00000X, 163WG0000X, 163WM0102X, 163WI0500X, 163WP0200X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WF0300XNursing Service ProvidersRegistered NurseFlight
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0200XNursing Service ProvidersRegistered NursePediatrics