Provider Demographics
NPI:1710994249
Name:FARIETTA MURRAY, TATYANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:TATYANNA
Middle Name:
Last Name:FARIETTA MURRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 N CORONA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1096
Mailing Address - Country:US
Mailing Address - Phone:520-469-8700
Mailing Address - Fax:
Practice Address - Street 1:6050 N CORONA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1096
Practice Address - Country:US
Practice Address - Phone:520-469-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME881382084P0800X
AZ413392084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272236400Medicaid
FL03441Medicare ID - Type Unspecified
FL272236400Medicaid