Provider Demographics
NPI:1053169219
Name:AUTREY, TIFFANY DARLENE (FNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DARLENE
Last Name:AUTREY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DARLENE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1637 N 66TH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-3741
Mailing Address - Country:US
Mailing Address - Phone:951-581-0998
Mailing Address - Fax:
Practice Address - Street 1:1637 N 66TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-3741
Practice Address - Country:US
Practice Address - Phone:951-581-0998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN209925163W00000X
AZ305685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse