Healthcare Provider Details

I. General information

NPI: 1518758127
Provider Name (Legal Business Name): TIFFANY A MAHER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 WASHINGTON DR STE 201
EAGAN MN
55122-1354
US

IV. Provider business mailing address

3500 AMERICAN BLVD W STE 300
BLOOMINGTON MN
55431-4442
US

V. Phone/Fax

Practice location:
  • Phone: 651-227-7806
  • Fax: 651-256-6744
Mailing address:
  • Phone: 952-512-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12904
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: