Healthcare Provider Details

I. General information

NPI: 1215871108
Provider Name (Legal Business Name): TIFFANY MARIE DAVIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9755 HAVASUPAI AVE
LAS VEGAS NV
89148-1675
US

IV. Provider business mailing address

9755 HAVASUPAI AVE
LAS VEGAS NV
89148-1675
US

V. Phone/Fax

Practice location:
  • Phone: 702-885-3999
  • Fax:
Mailing address:
  • Phone: 702-885-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: