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NPI Code Detail

MEDICARE: IVA TIRRES FNP

MEDICARE: IVA TIRRES FNP
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
1363L00000XNurse PractitionerF12190591AZ

General Provider Information

NPI Number : 1558972752
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVA TIRRES FNP
Provider Business Mailing Address
First Line : 3815 E BELL RD STE 2200
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-2139
Country : US
Telephone Number : 602-633-3848
Fax Number : 602-633-3841
Provider Business Practice Location Address
First Line : 3815 E BELL RD STE 3200
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-2162
Country : US
Telephone Number : 602-494-5040
Fax Number : 602-494-9736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2020
Last Update Date : 05/21/2024

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