Healthcare Provider Details

I. General information

NPI: 1619868627
Provider Name (Legal Business Name): TIARA FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5792 IRELAND RIDGE CT
LAS VEGAS NV
89149-1281
US

IV. Provider business mailing address

5792 IRELAND RIDGE CT
LAS VEGAS NV
89149-1281
US

V. Phone/Fax

Practice location:
  • Phone: 702-419-4055
  • Fax:
Mailing address:
  • Phone: 702-419-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberNV20212147109
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: