Healthcare Provider Details

I. General information

NPI: 1083691737
Provider Name (Legal Business Name): GILLIAN GENE TUFTS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 W 1000 N
SALT LAKE CITY UT
84116-1654
US

IV. Provider business mailing address

2621 S 3270 W
WEST VALLEY CITY UT
84119-1119
US

V. Phone/Fax

Practice location:
  • Phone: 801-328-5750
  • Fax:
Mailing address:
  • Phone: 385-261-2737
  • Fax: 801-746-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216178-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: