Individual
TIFFANI PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
395 W COUGAR BLVD STE 601, PROVO, UT 84604-3331
(801) 357-7525
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 357-7525
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
7453288-3102
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7453288-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7453288-8900
UT
Other
Enumeration date
03/25/2020
Last updated
01/27/2026
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