Provider Demographics
NPI:1477302115
Name:ROBERTSON, TIFFANY MANNO (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MANNO
Last Name:ROBERTSON
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 COURTHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2402
Mailing Address - Country:US
Mailing Address - Phone:225-603-4089
Mailing Address - Fax:
Practice Address - Street 1:44608 J MEADIE KNIGHT DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3696
Practice Address - Country:US
Practice Address - Phone:985-289-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily