Healthcare Provider Details

I. General information

NPI: 1952266652
Provider Name (Legal Business Name): TIARA SANK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 CORPORATE DR # 4483
JOHNSTON IA
50131-1659
US

IV. Provider business mailing address

6701 CORPORATE DR # 4483
JOHNSTON IA
50131-1659
US

V. Phone/Fax

Practice location:
  • Phone: 515-466-7760
  • Fax:
Mailing address:
  • Phone: 580-695-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG193363
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: