Healthcare Provider Details

I. General information

NPI: 1205433802
Provider Name (Legal Business Name): TIFFIN MARIE ZELLERS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 09/03/2022
Certification Date: 09/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 N ORCHARD
ESPANOLA NM
87532-3232
US

IV. Provider business mailing address

1308 N ORCHARD
ESPANOLA NM
87532-3232
US

V. Phone/Fax

Practice location:
  • Phone: 505-927-0157
  • Fax: 855-928-4040
Mailing address:
  • Phone: 505-927-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number60817
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: