Provider Demographics
NPI:1821685983
Name:PARKER, TIFFANY ELISE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELISE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13625 S 48TH ST APT 1056
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5046
Mailing Address - Country:US
Mailing Address - Phone:602-214-3939
Mailing Address - Fax:
Practice Address - Street 1:13625 S 48TH ST APT 1056
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5046
Practice Address - Country:US
Practice Address - Phone:602-214-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-16281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist