Provider Demographics
NPI:1669183240
Name:LOMAS, TIFFANY SHANTELL
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHANTELL
Last Name:LOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 N 3RD ST APT 218
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-5172
Mailing Address - Country:US
Mailing Address - Phone:225-588-7816
Mailing Address - Fax:
Practice Address - Street 1:1925 N 3RD ST APT 218
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-5172
Practice Address - Country:US
Practice Address - Phone:225-588-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3747P1801X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant