Provider Demographics
NPI:1225630833
Name:KOORS, TIFFANY M (NP-C)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:M
Last Name:KOORS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:O'KEEFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:218 NORTHPARKE DR STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1118
Mailing Address - Country:US
Mailing Address - Phone:937-210-4198
Mailing Address - Fax:
Practice Address - Street 1:218 NORTHPARKE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1118
Practice Address - Country:US
Practice Address - Phone:937-210-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027992363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner