Healthcare Provider Details

I. General information

NPI: 1952668444
Provider Name (Legal Business Name): MS. TIFFANY MONIQUE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY MONIQUE HOUSE

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8908 DISCOVERY REEF AVE
LAS VEGAS NV
89149-2970
US

IV. Provider business mailing address

8908 DISCOVERY REEF AVE
LAS VEGAS NV
89149-2970
US

V. Phone/Fax

Practice location:
  • Phone: 702-308-3012
  • Fax:
Mailing address:
  • Phone: 702-308-3012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number817918
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number817918
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number817918
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: