Provider Demographics
NPI:1922489160
Name:TORRES, AMBER T (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:T
Last Name:TORRES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:THIBODEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-369-6070
Mailing Address - Fax:
Practice Address - Street 1:114 HWY 403
Practice Address - Street 2:
Practice Address - City:PAINCOURTVILLE
Practice Address - State:LA
Practice Address - Zip Code:70391
Practice Address - Country:US
Practice Address - Phone:985-369-6070
Practice Address - Fax:985-369-3514
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA131334-8307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2399161Medicaid
LAP01609412OtherRAILROAD MEDICARE
LA431963ZQPDMedicare PIN
LAP01609412OtherRAILROAD MEDICARE