Healthcare Provider Details

I. General information

NPI: 1629997465
Provider Name (Legal Business Name): AGAVE MENTAL WELLNESS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7660 E BROADWAY BLVD STE 101
TUCSON AZ
85710-3759
US

IV. Provider business mailing address

1460 S AVENIDA LOS REYES
TUCSON AZ
85748-7720
US

V. Phone/Fax

Practice location:
  • Phone: 520-812-1462
  • Fax: 520-434-1311
Mailing address:
  • Phone: 520-812-1462
  • Fax: 520-434-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIANA TIBBETTS
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 520-490-3131