Provider Demographics
NPI:1750084778
Name:DUTTKO, TIFFANY ANNE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:DUTTKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16012 REMORA BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2218
Mailing Address - Country:US
Mailing Address - Phone:216-704-0699
Mailing Address - Fax:
Practice Address - Street 1:16012 REMORA BLVD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2218
Practice Address - Country:US
Practice Address - Phone:216-704-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care