Provider Demographics
NPI:1265887012
Name:THIBODEAUX, TIFFANY SAMPY (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:SAMPY
Last Name:THIBODEAUX
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LOUISE
Other - Last Name:SAMPY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3419 NW EVANGELINE TRWY STE H-3
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-6241
Mailing Address - Country:US
Mailing Address - Phone:337-520-2587
Mailing Address - Fax:337-520-2594
Practice Address - Street 1:3419 NW EVANGELINE TRWY STE H-3
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-6241
Practice Address - Country:US
Practice Address - Phone:337-520-2587
Practice Address - Fax:337-520-2594
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08711363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2427172Medicaid