Healthcare Provider Details

I. General information

NPI: 1093646937
Provider Name (Legal Business Name): TIFFANY STROUD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 N 72ND DR STE A105
GLENDALE AZ
85308-8557
US

IV. Provider business mailing address

17215 N 72ND DR STE A105
GLENDALE AZ
85308-8557
US

V. Phone/Fax

Practice location:
  • Phone: 480-393-3515
  • Fax: 480-361-4264
Mailing address:
  • Phone: 480-393-3515
  • Fax: 480-361-4264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number339884
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: