Provider Demographics
NPI:1174984199
Name:ROSS, TIFFANY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N ROLLING RD STE 305
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4142
Mailing Address - Country:US
Mailing Address - Phone:410-364-4994
Mailing Address - Fax:410-847-2327
Practice Address - Street 1:5457 TWIN KNOLLS RD STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3296
Practice Address - Country:US
Practice Address - Phone:410-971-2271
Practice Address - Fax:410-847-2327
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health