Healthcare Provider Details

I. General information

NPI: 1376240945
Provider Name (Legal Business Name): TIFFANY ANN CRIST PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 740
BEVERLY HILLS CA
90211-3105
US

IV. Provider business mailing address

8500 WILSHIRE BLVD STE 740
BEVERLY HILLS CA
90211-3105
US

V. Phone/Fax

Practice location:
  • Phone: 310-779-6242
  • Fax:
Mailing address:
  • Phone: 310-779-6242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: