Provider Demographics
NPI:1295385045
Name:SPICUZZA, TIFFANY ROPER (PNP-AC)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:ROPER
Last Name:SPICUZZA
Suffix:
Gender:F
Credentials:PNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 FAYEDAYE DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3171
Mailing Address - Country:US
Mailing Address - Phone:985-502-9045
Mailing Address - Fax:
Practice Address - Street 1:3663 HIGHWAY 190 STE 100
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3497
Practice Address - Country:US
Practice Address - Phone:985-272-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207500363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics