Healthcare Provider Details

I. General information

NPI: 1194172635
Provider Name (Legal Business Name): TIFFANY SCHULTZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2016
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 N SPRING CREEK PKWY
PROVIDENCE UT
84332-9775
US

IV. Provider business mailing address

257 E 500 N
LOGAN UT
84321-4128
US

V. Phone/Fax

Practice location:
  • Phone: 435-792-9400
  • Fax: 435-792-4800
Mailing address:
  • Phone: 801-528-2619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7218743-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7218743-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: