Healthcare Provider Details

I. General information

NPI: 1255708061
Provider Name (Legal Business Name): TIFFANY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY CAROL RIDDLE

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 E JASPER DR
GILBERT AZ
85296-8255
US

IV. Provider business mailing address

3930 E JASPER DR
GILBERT AZ
85296-8255
US

V. Phone/Fax

Practice location:
  • Phone: 801-834-8067
  • Fax:
Mailing address:
  • Phone: 801-834-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number7707374-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: