Provider Demographics
NPI:1225296981
Name:MILLS, TIFFANI KAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:KAY
Last Name:MILLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11015 N. 139TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4349
Mailing Address - Country:US
Mailing Address - Phone:623-910-5400
Mailing Address - Fax:623-792-5653
Practice Address - Street 1:14811 W. BELL RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7602
Practice Address - Country:US
Practice Address - Phone:623-815-9073
Practice Address - Fax:623-815-9201
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2961363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant