Provider Demographics
NPI:1942911680
Name:MADSEN, TIFFANY POWERS (PMHNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:POWERS
Last Name:MADSEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11025 S 51ST ST APT 2058
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1758
Mailing Address - Country:US
Mailing Address - Phone:480-307-0096
Mailing Address - Fax:
Practice Address - Street 1:11025 S 51ST ST APT 2058
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1758
Practice Address - Country:US
Practice Address - Phone:480-307-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ249522363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health