Individual provider Active NPI

Tiffany Marie Wallace

  • Acute Care Nurse Practitioner
  • Zanesville, OH
National Provider Identifier
1609740448
Registry record updated Oct 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
RN.464702 Issued in OH
Practice address
999 Garden Rd
Zanesville, OH 43701-1330
Phone
(740) 454-8193
NPI assigned
Oct 3, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X RN.464702 OH Primary

Addresses

Primary practice location

999 Garden Rd
Zanesville, OH 43701-1330

Mailing address

222 10TH St
Malta, OH 43758-9383
Phone (740) 297-9779

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
I20260218003663 OH Practitioner - Nurse Practitioner 1456831346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Medical Group, LLCGroup PAC ID 7719040385, 265 clinicians

Practice addresses (Care Compare)

999 Garden Rd
Zanesville, OH 43701-1330
Phone (740) 454-8193

Hospital & facility affiliations

  • Genesis Hospital Hospital, Zanesville, OH, CCN 360039

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN.464702OHMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Medical Group LLC CurrentSince Jan 4, 2026 Accepting new patients
Genesis Medical Group, LLC CurrentSince Jan 4, 2026 Accepting new patients

Locations

945 Bethesda Dr
Ste 330
Zanesville, OH 43701
Phone (740) 454-4038

999 Garden Rd
Zanesville, OH 43701
Phone (740) 454-8193

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1759449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759449600000",
    "number": "1609740448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 10TH ST",
            "city": "MALTA",
            "state": "OH",
            "postal_code": "437589383",
            "telephone_number": "740-297-9779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 GARDEN RD",
            "city": "ZANESVILLE",
            "state": "OH",
            "postal_code": "437011330",
            "telephone_number": "740-454-8193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TIFFANY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-03",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "RN.464702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Zanesville, OH

Sources for this page

Verify at the official NPI Registry.