Provider Demographics
NPI:1477524916
Name:TIFFANY NELSON MD PLC
Entity Type:Organization
Organization Name:TIFFANY NELSON MD PLC
Other - Org Name:DESERT RIDGE FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-607-0060
Mailing Address - Street 1:20940 N TATUM BLVD
Mailing Address - Street 2:#300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4265
Mailing Address - Country:US
Mailing Address - Phone:480-607-0060
Mailing Address - Fax:480-607-5809
Practice Address - Street 1:20940 N TATUM BLVD
Practice Address - Street 2:#300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4265
Practice Address - Country:US
Practice Address - Phone:480-607-0060
Practice Address - Fax:480-607-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ81596Medicare PIN