Individual
TYANNA K MONTIJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
5555 E BASELINE RD, MESA, AZ 85206-4709
(480) 393-0575
Mailing address
5555 E BASELINE RD, MESA, AZ 85206-4709
(480) 393-0575
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
251194
AZ
Other
Enumeration date
01/04/2021
Last updated
08/24/2022
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