Provider Demographics
NPI:1639887185
Name:SMITH, TIFFANY JORDAN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JORDAN
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 CARYL DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146
Mailing Address - Country:US
Mailing Address - Phone:419-217-2884
Mailing Address - Fax:
Practice Address - Street 1:23425 COMMERCE PARK STE 104
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5848
Practice Address - Country:US
Practice Address - Phone:216-831-2900
Practice Address - Fax:216-831-4306
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH452706163WP0809X
OH0035137363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult