Provider Demographics
NPI:1679840508
Name:DOUGLAS MIKSCH, TIFFANI DIANE (RN)
Entity type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:DIANE
Last Name:DOUGLAS MIKSCH
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:19365 N SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3006
Mailing Address - Country:US
Mailing Address - Phone:520-709-9498
Mailing Address - Fax:520-568-5110
Practice Address - Street 1:44150 W MARICOPA CASA GRANDE HWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5900
Practice Address - Country:US
Practice Address - Phone:520-568-5100
Practice Address - Fax:520-568-5110
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN171041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse