Healthcare Provider Details

I. General information

NPI: 1417219338
Provider Name (Legal Business Name): TIFFANEY CRYMES BRITT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON ST
MONROE LA
71202-6400
US

IV. Provider business mailing address

1431 DALZELL STREET ATTN: MANAGED CARE
SHREVEPORT LA
71103-3709
US

V. Phone/Fax

Practice location:
  • Phone: 318-330-7000
  • Fax:
Mailing address:
  • Phone: 318-626-0265
  • Fax: 318-629-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09555
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN108342
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: