Healthcare Provider Details

I. General information

NPI: 1871412890
Provider Name (Legal Business Name): TIFFANY LASHONE BORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3367 W PARK AVE
GRAY LA
70359-3401
US

IV. Provider business mailing address

3367 W PARK AVE
GRAY LA
70359-3401
US

V. Phone/Fax

Practice location:
  • Phone: 504-396-9137
  • Fax:
Mailing address:
  • Phone: 504-396-9137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number006050477
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: