Provider Demographics
NPI:1225052145
Name:BARNETT, TIFFANY A (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:A
Last Name:BARNETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:A
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3048 E BASELINE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7287
Mailing Address - Country:US
Mailing Address - Phone:480-632-1117
Mailing Address - Fax:480-632-1118
Practice Address - Street 1:110 N 66TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2402
Practice Address - Country:US
Practice Address - Phone:402-325-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2400363LF0000X, 363L00000X
NJ26NJ00308500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ113772Medicare PIN
Q76301Medicare UPIN
NJQ76301Medicare UPIN