Healthcare Provider Details

I. General information

NPI: 1982249587
Provider Name (Legal Business Name): TIFFANY ANN HAAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY ANN ELLIS FNP-C

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3221
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3221
US

V. Phone/Fax

Practice location:
  • Phone: 760-837-8880
  • Fax: 760-837-8882
Mailing address:
  • Phone: 760-837-8880
  • Fax: 760-837-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: