Provider Demographics
NPI:1679913115
Name:WILLIAMS, TIFFANY TEAL (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TEAL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 NORTH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3658
Mailing Address - Country:US
Mailing Address - Phone:318-443-4576
Mailing Address - Fax:318-449-5579
Practice Address - Street 1:3704 NORTH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3658
Practice Address - Country:US
Practice Address - Phone:318-443-4576
Practice Address - Fax:318-449-5579
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN119235163W00000X
LAAP07330363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse