Healthcare Provider Details

I. General information

NPI: 1821484080
Provider Name (Legal Business Name): TIFFANY WESLEY ARDOIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY WESLEY MD

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5246 BRITTANY DR
BATON ROUGE LA
70808
US

IV. Provider business mailing address

5131 ODONOVAN DR
BATON ROUGE LA
70808-4791
US

V. Phone/Fax

Practice location:
  • Phone: 225-757-4300
  • Fax:
Mailing address:
  • Phone: 225-374-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number303945
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number303945
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: