Provider Demographics
NPI:1801335195
Name:STUREY, TIFFANY (PA-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:STUREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 GREAT OAK WAY
Mailing Address - Street 2:APT. E
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4509
Mailing Address - Country:US
Mailing Address - Phone:814-720-8101
Mailing Address - Fax:
Practice Address - Street 1:5350 GREAT OAK WAY
Practice Address - Street 2:APT. E
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4509
Practice Address - Country:US
Practice Address - Phone:814-720-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005009RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant