Provider Demographics
NPI:1326677873
Name:BOURGEOIS, TIFFANIE (NP-C)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 REMY DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5932
Mailing Address - Country:US
Mailing Address - Phone:985-212-9604
Mailing Address - Fax:
Practice Address - Street 1:2450 SEVERN AVE STE 315
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-6949
Practice Address - Country:US
Practice Address - Phone:504-834-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily