Provider Demographics
NPI:1457820334
Name:MILLETT, TIFFANY S (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:MILLETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N 7TH ST STE 375
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2707
Mailing Address - Country:US
Mailing Address - Phone:602-307-0070
Mailing Address - Fax:023-070-0806
Practice Address - Street 1:1331 N 7TH ST STE 375
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2707
Practice Address - Country:US
Practice Address - Phone:602-307-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59613363LF0000X
AZ291905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily