Healthcare Provider Details

I. General information

NPI: 1871404426
Provider Name (Legal Business Name): TANZANEA VILLACISMENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GALLOWAY ST
HAMMOND LA
70402-1003
US

IV. Provider business mailing address

2222 CEDAR WAY
BATON ROUGE LA
70806-4960
US

V. Phone/Fax

Practice location:
  • Phone: 985-549-2253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: