Tiffany Sidra Taylor-Mduba, APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

95020695 Issued in CA

Practice address

58375 Twentynine Palms Hwy
Suite B
Yucca Valley, CA 92284

Phone

(760) 365-9305

NPI assigned

Apr 25, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Tiffany Sidra Mduba Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hi -Desert Memorial Health Care District

  • Federally Qualified Health Center (FQHC)
  • Yucca Valley, CA
  • NPI 1841612082
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1508500760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7760 BALSA AVE",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922848500",
            "telephone_number": "267-648-0351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58375 TWENTYNINE PALMS HWY",
            "address_2": "SUITE B",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "92284",
            "telephone_number": "760-365-9305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR-MDUBA",
        "first_name": "TIFFANY",
        "middle_name": "SIDRA",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-25",
        "last_updated": "2022-04-25",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "818748",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95020695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "MDUBA",
            "middle_name": "SIDRA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Colleen E Tahbo
• Julieann Tamminga
• Lorayne C. Tapia
• Kristina Tareila
• Mato Tatu
• De Anna Marie Taylor, MSN, FNP-BC
• Steven Teeters
• Telecare Corp
• Telecare Corp
• Telecare Corporation

• Pediatric Nurse Practitioner in Yucca Valley, CA
• Providers in Yucca Valley, CA by specialty
• Pediatric Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.