Provider Demographics
NPI:1962975953
Name:RYAN, TIFFANY BRISKEN (BSN, RN, PHN)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:BRISKEN
Last Name:RYAN
Suffix:
Gender:F
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18159 BALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-6146
Mailing Address - Country:US
Mailing Address - Phone:818-481-6588
Mailing Address - Fax:
Practice Address - Street 1:18159 BALLARD AVE
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-6146
Practice Address - Country:US
Practice Address - Phone:818-481-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95092200163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95092200OtherBRN