Healthcare Provider Details

I. General information

NPI: 1639612856
Provider Name (Legal Business Name): TIFFANY ANN NOETZEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2016
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 E BASELINE RD STE 126
MESA AZ
85209-5006
US

IV. Provider business mailing address

250 W CHANDLER HEIGHTS RD
CHANDLER AZ
85248-5055
US

V. Phone/Fax

Practice location:
  • Phone: 480-868-9650
  • Fax: 480-834-3606
Mailing address:
  • Phone: 480-659-2759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9663
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: