Healthcare Provider Details

I. General information

NPI: 1760629042
Provider Name (Legal Business Name): TIFFANY LYNN BRAINERD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

1301 MEDICAL CENTER DR
NASHVILLE TN
37232-5614
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4045
  • Fax:
Mailing address:
  • Phone: 615-322-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number61969
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41174
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0053639
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: