Provider Demographics
NPI:1104411016
Name:BOYER, TIFFANY S (LMT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:BOYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6872 WADSWORTH BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-3406
Mailing Address - Country:US
Mailing Address - Phone:303-499-1920
Mailing Address - Fax:
Practice Address - Street 1:6872 WADSWORTH BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-3406
Practice Address - Country:US
Practice Address - Phone:303-499-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMEDICAIDMedicaid