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General NPI Number Information
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NPI Number | 1104803543
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Entity Type | Individual
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Provider Name | TIFFANY ANN CERVENAK NP
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Gender | Female
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 24012 CALLE DE LA PLATA SUITE 150
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3621
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Country | US
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Telephone | 949-837-1578
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Fax | 949-837-8154
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Provider Business Mailing Address
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Address Line | 3080 BRISTOL ST SUITE 600
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City | COSTA MESA
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State | CA
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Zip | 92626-3093
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Country | US
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Telephone | 714-445-0220
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Fax | 714-445-0245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10177
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License Number State | CA
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