Healthcare Provider Details

I. General information

NPI: 1225549793
Provider Name (Legal Business Name): TATHA MARIE ENZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 N 2000 E
LAYTON UT
84040-2305
US

IV. Provider business mailing address

1951 N 2000 E
LAYTON UT
84040-2305
US

V. Phone/Fax

Practice location:
  • Phone: 801-721-0334
  • Fax:
Mailing address:
  • Phone: 801-721-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216202-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: