Healthcare Provider Details

I. General information

NPI: 1669183240
Provider Name (Legal Business Name): TIFFANY SHANTELL LOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 N 3RD ST APT 218
BATON ROUGE LA
70802-5172
US

IV. Provider business mailing address

1925 N 3RD ST APT 218
BATON ROUGE LA
70802-5172
US

V. Phone/Fax

Practice location:
  • Phone: 225-588-7816
  • Fax:
Mailing address:
  • Phone: 225-588-7816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: