Healthcare Provider Details

I. General information

NPI: 1790406767
Provider Name (Legal Business Name): BETHANY C TONGUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NAPOLEON AVE
NEW ORLEANS LA
70115-6914
US

IV. Provider business mailing address

320 RACETRACK RD NW STE 100A
FORT WALTON BEACH FL
32547-1796
US

V. Phone/Fax

Practice location:
  • Phone: 504-894-2880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN9349846
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11022540
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number234958
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number234958
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: