Healthcare Provider Details

I. General information

NPI: 1821903816
Provider Name (Legal Business Name): TIFFANY NGACHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 JOHN HENRY CIR
FOLSOM CA
95630-8113
US

IV. Provider business mailing address

177 JOHN HENRY CIR
FOLSOM CA
95630-8113
US

V. Phone/Fax

Practice location:
  • Phone: 443-474-7780
  • Fax:
Mailing address:
  • Phone: 443-474-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95420889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: