Provider Demographics
NPI:1447743133
Name:GROSS, TIFFANY A (RN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:GROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 SE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2161
Mailing Address - Country:US
Mailing Address - Phone:503-655-8401
Mailing Address - Fax:
Practice Address - Street 1:6605 SE LAKE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2161
Practice Address - Country:US
Practice Address - Phone:503-982-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201609693163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse