Provider Demographics
NPI:1154824233
Name:LYNCH, TIFFANY (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 E CALLE MADERO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7900 S J STOCK RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-7012
Practice Address - Country:US
Practice Address - Phone:520-295-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2021-09-02
Deactivation Date:2019-06-25
Deactivation Code:
Reactivation Date:2021-09-02
Provider Licenses
StateLicense IDTaxonomies
AZ150138163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse