Healthcare Provider Details

I. General information

NPI: 1629320189
Provider Name (Legal Business Name): TIFFANY PARKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W. ELLIOT ROAD SUITE 103
GILBERT AZ
85233
US

IV. Provider business mailing address

800 W. ELLIOT ROAD SUITE 103
GILBERT AZ
85233
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2787
  • Fax: 484-545-1434
Mailing address:
  • Phone: 480-545-2787
  • Fax: 484-545-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: