Healthcare Provider Details

I. General information

NPI: 1629065206
Provider Name (Legal Business Name): TIFFANY MICHELLE TAPIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 N METRO PKWY E
PHOENIX AZ
85051-1513
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 602-249-0115
  • Fax: 602-246-0837
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3045
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: