=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558972752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVA TIRRES FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2020
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3815 E BELL RD STE 3200
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85032-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-494-5040
-----------------------------------------------------
Fax | 602-494-9736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3815 E BELL RD STE 2200
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85032-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-633-3848
-----------------------------------------------------
Fax | 602-633-3841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F12190591
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------