Healthcare Provider Details

I. General information

NPI: 1700704038
Provider Name (Legal Business Name): HEALING TIDE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32808 N CROZIER RD
WITTMANN AZ
85361-9997
US

IV. Provider business mailing address

32808 N CROZIER RD
WITTMANN AZ
85361-9997
US

V. Phone/Fax

Practice location:
  • Phone: 602-410-1898
  • Fax:
Mailing address:
  • Phone: 602-410-1898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAYLA BERRY
Title or Position: OWNER
Credential: FNP
Phone: 623-742-8819