Healthcare Provider Details

I. General information

NPI: 1992162515
Provider Name (Legal Business Name): SAMANTHA TIBLIER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 1008
BATON ROUGE LA
70808-4368
US

IV. Provider business mailing address

7777 HENNESSY BLVD STE 1008
BATON ROUGE LA
70808-4368
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-0416
  • Fax: 225-769-9212
Mailing address:
  • Phone: 225-766-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08630
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN134230
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: