Healthcare Provider Details

I. General information

NPI: 1457820334
Provider Name (Legal Business Name): TIFFANY S MILLETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 07/21/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST STE 375
PHOENIX AZ
85006-2707
US

IV. Provider business mailing address

1331 N 7TH ST STE 375
PHOENIX AZ
85006-2707
US

V. Phone/Fax

Practice location:
  • Phone: 602-307-0070
  • Fax:
Mailing address:
  • Phone: 602-307-0070
  • Fax: 23-070-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59613
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number291905
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: