Provider Demographics
NPI:1578244828
Name:CAVALIER, TIFFANY N (FNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:CAVALIER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8907 REDWOOD LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-8341
Mailing Address - Country:US
Mailing Address - Phone:225-620-3390
Mailing Address - Fax:
Practice Address - Street 1:8907 REDWOOD LAKE BLVD
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-8341
Practice Address - Country:US
Practice Address - Phone:225-620-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF06231776363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner