Provider Demographics
NPI:1598375800
Name:WILES, TIFFANY LORRAINE (FNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LORRAINE
Last Name:WILES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 W AGUA FRIA FWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3946
Mailing Address - Country:US
Mailing Address - Phone:602-802-8388
Mailing Address - Fax:
Practice Address - Street 1:3050 W AGUA FRIA FWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3946
Practice Address - Country:US
Practice Address - Phone:602-802-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX933195163WC0200X
TX1029194363L00000X, 363LF0000X
AZ312637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily