Healthcare Provider Details

I. General information

NPI: 1336010768
Provider Name (Legal Business Name): BRIANA LEE TIBBETTS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9172 S HOUGHTON RD STE 130
TUCSON AZ
85747-9748
US

IV. Provider business mailing address

42 N ATRISCO DR
VAIL AZ
85641-9445
US

V. Phone/Fax

Practice location:
  • Phone: 520-812-1462
  • Fax:
Mailing address:
  • Phone: 520-490-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number291921
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: