Provider Demographics
NPI:1376010538
Name:POWERS-PARKER, TIFFONE NUBARKA
Entity Type:Individual
Prefix:
First Name:TIFFONE
Middle Name:NUBARKA
Last Name:POWERS-PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFONE
Other - Middle Name:NUBARKA
Other - Last Name:POWERS-PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2734 S WESLEY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-7936
Mailing Address - Country:US
Mailing Address - Phone:480-390-2061
Mailing Address - Fax:
Practice Address - Street 1:2734 S WESLEY
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-7936
Practice Address - Country:US
Practice Address - Phone:480-390-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2023-04-24
Deactivation Date:2023-03-14
Deactivation Code:
Reactivation Date:2023-04-24
Provider Licenses
StateLicense IDTaxonomies
AZ86018338133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered