Provider Demographics
NPI:1821221847
Name:MITCHELL, TIFFANY NICOLE (NMD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:NICOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:NICOLE
Other - Last Name:SATTERFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13660 N 94TH DR
Mailing Address - Street 2:STE C-4
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4836
Mailing Address - Country:US
Mailing Address - Phone:623-266-1722
Mailing Address - Fax:623-266-1746
Practice Address - Street 1:13660 N 94TH DR
Practice Address - Street 2:STE C-4
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4836
Practice Address - Country:US
Practice Address - Phone:623-266-1722
Practice Address - Fax:623-266-1746
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08-1064175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath