Healthcare Provider Details

I. General information

NPI: 1730683319
Provider Name (Legal Business Name): TIFFANY WALKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1600
ORANGE CA
92868-4698
US

IV. Provider business mailing address

7421 MARGOLLINI ST
LAS VEGAS NV
89148-2670
US

V. Phone/Fax

Practice location:
  • Phone: 833-402-5803
  • Fax:
Mailing address:
  • Phone: 702-767-9346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN002775
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN002775
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN002775
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: