Individual provider Active NPI

Tiffany Nicole Mitchell, NP

  • Gerontology Nurse Practitioner
  • Oakwood, OH
National Provider Identifier
1104602614
Registry record updated Oct 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
AG08230123 Issued in OH
Practice address
1110 Oakwood Ave
Oakwood, OH 45419-2911
Phone
(937) 885-7163
NPI assigned
Aug 31, 2023
Last updated
Oct 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AG08230123 OH Primary
Geriatric Medicine (Family Medicine) Physician 207QG0300X AG08230123 OH
Geriatric Medicine (Internal Medicine) Physician 207RG0300X AG08230123 OH

Addresses

Primary practice location

1110 Oakwood Ave
Oakwood, OH 45419-2911

Mailing address

10357 S Union Rd
Miamisburg, OH 45342-4617
Phone (937) 286-7457

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240425001310 OH Practitioner - Nurse Practitioner 1658711544 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Geriatric Care, LLCGroup PAC ID 3476642901, 9 clinicians

Practice addresses (Care Compare)

1390 King Tree Dr
Dayton, OH 45405-1401
Phone (937) 885-7163

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AG08230123OHMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jewel a Stevens MD LLC CurrentSince May 1, 2024 Accepting new patients
Comprehensive Geriatric Care, LLC Geriatric Medicine CurrentSince Apr 15, 2025 Accepting new patients

Locations

1390 King Tree Dr
Dayton, OH 45405
Phone (718) 280-5436

300 Business Pkwy
Franklin, OH 45005
Phone (937) 746-2813

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791158400000",
    "number": "1104602614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10357 S UNION RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453424617",
            "telephone_number": "937-286-7457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 OAKWOOD AVE",
            "city": "OAKWOOD",
            "state": "OH",
            "postal_code": "454192911",
            "telephone_number": "937-885-7163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "TIFFANY",
        "middle_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-31",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "AG08230123",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "AG08230123",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "AG08230123",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakwood, OH

Sources for this page

Verify at the official NPI Registry.