Provider Demographics
NPI:1215405972
Name:SARPY, TIFFANY DANITA
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DANITA
Last Name:SARPY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31165 TEMECULA PKWY STE G32035
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2908
Mailing Address - Country:US
Mailing Address - Phone:951-821-8303
Mailing Address - Fax:
Practice Address - Street 1:31165 TEMECULA PKWY STE G3-2035
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2908
Practice Address - Country:US
Practice Address - Phone:951-821-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-10
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273268164X00000X
CA95318903163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse