Healthcare Provider Details

I. General information

NPI: 1114837846
Provider Name (Legal Business Name): TIFFANY BURKART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 E WAPITI TRL
FLAGSTAFF AZ
86004-1579
US

IV. Provider business mailing address

10101 E WAPITI TRL
FLAGSTAFF AZ
86004-1579
US

V. Phone/Fax

Practice location:
  • Phone: 928-607-8201
  • Fax:
Mailing address:
  • Phone: 928-607-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number259600
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: