Provider Demographics
NPI:1922657121
Name:COLORADO, TIFFANY JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JEAN
Last Name:COLORADO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:JEAN
Other - Last Name:BEGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19829 N 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4001
Mailing Address - Country:US
Mailing Address - Phone:623-879-5288
Mailing Address - Fax:
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4001
Practice Address - Country:US
Practice Address - Phone:623-879-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty