Healthcare Provider Details

I. General information

NPI: 1871427419
Provider Name (Legal Business Name): TIFFANY NGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 ADAMS BLVD
BOULDER CITY NV
89005-2235
US

IV. Provider business mailing address

2841 MONTAGE SUN RD UNIT 4
LAS VEGAS NV
89183-5985
US

V. Phone/Fax

Practice location:
  • Phone: 702-293-0406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number820691
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: