Healthcare Provider Details

I. General information

NPI: 1689936296
Provider Name (Legal Business Name): TIFFANY KIMIKO THORNTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2012
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5780 N SWAN RD STE 180
TUCSON AZ
85718-4530
US

IV. Provider business mailing address

5780 N SWAN RD STE 180
TUCSON AZ
85718-4530
US

V. Phone/Fax

Practice location:
  • Phone: 520-448-9490
  • Fax: 520-448-9492
Mailing address:
  • Phone: 520-448-9490
  • Fax: 520-448-9492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR73309
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: