Healthcare Provider Details

I. General information

NPI: 1538257720
Provider Name (Legal Business Name): TIFFANY ANN PYLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 W 7000 S
WEST JORDAN UT
84084-3431
US

IV. Provider business mailing address

1575 W 7000 S
WEST JORDAN UT
84084-3431
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-9133
  • Fax: 801-569-9103
Mailing address:
  • Phone: 801-569-9133
  • Fax: 801-569-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62952171206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: