Healthcare Provider Details

I. General information

NPI: 1285224220
Provider Name (Legal Business Name): TIFFANY JEANETTE ELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 NORTHWAY DR
ANCHORAGE AK
99508-2030
US

IV. Provider business mailing address

729 NORTHWAY DR
ANCHORAGE AK
99508-2030
US

V. Phone/Fax

Practice location:
  • Phone: 907-644-3239
  • Fax: 907-644-3983
Mailing address:
  • Phone: 907-644-3239
  • Fax: 907-644-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number174813
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: