Active NPI
Tiffany Ann Cervenak, NP
- Nurse Practitioner
- Laguna Hills, CA
National Provider Identifier
1104803543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 10177
- Practice address
- 24012 Calle de la Plata
Suite 150
Laguna Hills, CA 92653-3621 - Phone
- (949) 837-1578
- Fax
- (949) 837-8154
- NPI assigned
- Dec 28, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 10177 | CA | Primary |
Addresses
Primary practice location
24012 Calle de la Plata
Suite 150
Laguna Hills, CA 92653-3621
Mailing address
3080 Bristol St
Suite 600
Costa Mesa, CA 92626-3093
Phone (714) 445-0220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10177 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1104803543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3080 BRISTOL ST",
"address_2": "SUITE 600",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926263093",
"telephone_number": "714-445-0220",
"fax_number": "714-445-0245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24012 CALLE DE LA PLATA",
"address_2": "SUITE 150",
"city": "LAGUNA HILLS",
"state": "CA",
"postal_code": "926533621",
"telephone_number": "949-837-1578",
"fax_number": "949-837-8154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERVENAK",
"first_name": "TIFFANY",
"middle_name": "ANN",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-28",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "10177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laguna Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.