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General NPI Number Information
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NPI Number | 1629997465
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Entity Type | Organization
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Legal Business Name | AGAVE MENTAL WELLNESS INSTITUTE
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 7660 E BROADWAY BLVD STE 101
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City | TUCSON
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State | AZ
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Zip | 85710-3759
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Country | US
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Telephone | 520-812-1462
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Fax | 520-434-1311
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Provider Business Mailing Address
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Address Line | 1460 S AVENIDA LOS REYES
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City | TUCSON
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State | AZ
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Zip | 85748-7720
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Country | US
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Telephone | 520-812-1462
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Fax | 520-434-1311
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Authorized Official
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Title or Position | OWNER
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Name | BRIANA TIBBETTS
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Credential | PMHNP-BC
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Telephone | 520-490-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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