Provider Demographics
NPI:1912299611
Name:SANDY, TIFFANY A (APN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:SANDY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2895
Mailing Address - Country:US
Mailing Address - Phone:702-263-1908
Mailing Address - Fax:702-263-0195
Practice Address - Street 1:2621 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2895
Practice Address - Country:US
Practice Address - Phone:702-263-1908
Practice Address - Fax:702-263-0195
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV001271363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics