Healthcare Provider Details

I. General information

NPI: 1558972752
Provider Name (Legal Business Name): IVA TIRRES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E BELL RD STE 3200
PHOENIX AZ
85032-2162
US

IV. Provider business mailing address

3815 E BELL RD STE 2200
PHOENIX AZ
85032-2139
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-5040
  • Fax: 602-494-9736
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF12190591
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: