Provider Demographics
NPI:1700846599
Name:SIMPSON-VASSALL, TIFFANY (NP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SIMPSON-VASSALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2702 NORTH 3RD STREET
Mailing Address - Street 2:SUITE 4020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4608
Mailing Address - Country:US
Mailing Address - Phone:602-323-3344
Mailing Address - Fax:602-323-3496
Practice Address - Street 1:1492 SOUTH MILL AVENUE
Practice Address - Street 2:SUITE 312
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5676
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:480-927-1092
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN109710163W00000X
AZAP1935363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ863648Medicaid
AZZ149658Medicare UPIN
AZ863648Medicaid
Q50123Medicare UPIN