Provider Demographics
NPI:1881692622
Name:DOOLEY, TISHA (CFNP)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0002
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:2647 S SAINT ELIZABETH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5019
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-644-5415
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1564877Medicaid
LA5X930Medicare PIN
LA584510Medicare UPIN