Individual
TIFFANY TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(206) 552-4441
Mailing address
9900 BREN RD E, MINNETONKA, MN 55343-9664
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP61398231
WA
Other
Enumeration date
01/30/2023
Last updated
04/07/2023
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