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General NPI Number Information
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NPI Number | 1700704038
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Entity Type | Organization
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Legal Business Name | HEALING TIDE MEDICAL
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 32808 N CROZIER RD
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City | WITTMANN
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State | AZ
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Zip | 85361-9997
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Country | US
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Telephone | 602-410-1898
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Fax |
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Provider Business Mailing Address
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Address Line | 32808 N CROZIER RD
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City | WITTMANN
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State | AZ
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Zip | 85361-9997
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Country | US
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Telephone | 602-410-1898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAYLA BERRY
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Credential | FNP
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Telephone | 623-742-8819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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