Healthcare Provider Details

I. General information

NPI: 1871457697
Provider Name (Legal Business Name): TIFFANY CECILIA ADAMES FNP-BC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 W REUNION AVE STE 5A
SOUTH JORDAN UT
84095-4620
US

IV. Provider business mailing address

11267 S GLEN CROFT LN
SANDY UT
84070-6783
US

V. Phone/Fax

Practice location:
  • Phone: 385-361-3001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12782635-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: