Healthcare Provider Details

I. General information

NPI: 1215405972
Provider Name (Legal Business Name): TIFFANY DANITA SARPY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2018
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31165 TEMECULA PKWY STE G3-2035
TEMECULA CA
92592-2908
US

IV. Provider business mailing address

31165 TEMECULA PKWY STE G32035
TEMECULA CA
92592-2908
US

V. Phone/Fax

Practice location:
  • Phone: 951-821-8303
  • Fax:
Mailing address:
  • Phone: 951-821-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037168
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95318903
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number273268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: