Healthcare Provider Details

I. General information

NPI: 1750865564
Provider Name (Legal Business Name): TIFFANY LYNN COHEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12950 W VARNEY RD
EL MIRAGE AZ
85335-3184
US

IV. Provider business mailing address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7944
  • Fax:
Mailing address:
  • Phone: 623-876-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN193452
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: