Provider Demographics
NPI:1013424670
Name:TOLLIVER-BATTLE, TIFFANY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:TOLLIVER-BATTLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:TOLLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0293
Mailing Address - Country:US
Mailing Address - Phone:318-283-3970
Mailing Address - Fax:318-239-8970
Practice Address - Street 1:420 GUNBY AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4406
Practice Address - Country:US
Practice Address - Phone:318-283-3920
Practice Address - Fax:318-239-8920
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2466135Medicaid