Provider Demographics
NPI:1942608997
Name:ROBERTSON, TANGELA DENISE (NP)
Entity Type:Individual
Prefix:
First Name:TANGELA
Middle Name:DENISE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TANGELA
Other - Middle Name:DENISE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-3618
Mailing Address - Country:US
Mailing Address - Phone:985-354-6081
Mailing Address - Fax:985-354-6081
Practice Address - Street 1:215 EVERETT ST
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-3618
Practice Address - Country:US
Practice Address - Phone:985-354-6081
Practice Address - Fax:985-354-6087
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08081363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2386425Medicaid
LA403958Medicare PIN