Healthcare Provider Details

I. General information

NPI: 1720814478
Provider Name (Legal Business Name): TIFFANY CHOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16421 N TATUM BLVD STE 203
PHOENIX AZ
85032-3457
US

IV. Provider business mailing address

16421 N TATUM BLVD STE 203
PHOENIX AZ
85032-3457
US

V. Phone/Fax

Practice location:
  • Phone: 602-345-0466
  • Fax: 727-245-0166
Mailing address:
  • Phone: 602-345-0466
  • Fax: 727-245-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number253683
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: