MEDICARE: TIFFANY A SANDY APN

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	363LP0200X	Pediatric Nurse Practitioner	001271	NV

General Provider Information

NPI Number	:	1912299611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY A SANDY APN

Provider Business Mailing Address
First Line	:	2621 W HORIZON RIDGE PKWY
Second Line	:	SUITE 100
City	:	HENDERSON
State	:	NV
Zip	:	89052-2895
Country	:	US
Telephone Number	:	702-263-1908
Fax Number	:	702-263-0195

Provider Business Practice Location Address
First Line	:	2621 W HORIZON RIDGE PKWY
Second Line	:	SUITE 100
City	:	HENDERSON
State	:	NV
Zip	:	89052-2895
Country	:	US
Telephone Number	:	702-263-1908
Fax Number	:	702-263-0195

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

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	05/13/2011

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Directions to “ TIFFANY A SANDY APN” Practice Location

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