MEDICARE: TIFFANY LUC NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN205625	AZ
2	363LF0000X	Family Nurse Practitioner	296497	AZ

General Provider Information

NPI Number	:	1164108205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY LUC NP

Provider Business Mailing Address
First Line	:	4555 E INVERNESS AVE BLDG 3
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4555 E INVERNESS AVE BLDG 3
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4630
Country	:	US
Telephone Number	:	480-361-0110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	03/11/2026

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Directions to “ TIFFANY LUC NP” Practice Location

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