Provider Demographics
NPI:1669735940
Name:WOLFE, TIFFANY JANE (FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JANE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3919
Mailing Address - Country:US
Mailing Address - Phone:740-353-5153
Mailing Address - Fax:740-351-0694
Practice Address - Street 1:12340 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-8968
Practice Address - Country:US
Practice Address - Phone:740-941-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13366-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily