Healthcare Provider Details

I. General information

NPI: 1093180093
Provider Name (Legal Business Name): TIFFANY WALDROP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33016 N 60TH ST
SCOTTSDALE AZ
85266-5245
US

IV. Provider business mailing address

40108 N FAITH LN
ANTHEM AZ
85086-1691
US

V. Phone/Fax

Practice location:
  • Phone: 480-575-2000
  • Fax:
Mailing address:
  • Phone: 623-210-5102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN095292
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: