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General NPI Number Information
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NPI Number | 1780211524
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Entity Type | Individual
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Provider Name | TIFFANY JONIQUE SYLVESTER
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 14833 W ASHLAND AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-1671
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Country | US
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Telephone | 602-348-2224
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Fax |
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Provider Business Mailing Address
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Address Line | 16000 W MARICOPA ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-2858
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Country | US
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Telephone | 602-571-2955
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Fax |
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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 | 236453
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 236453
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 236453
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License Number State | AZ
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