Healthcare Provider Details

I. General information

NPI: 1912792672
Provider Name (Legal Business Name): TIFFANIE NEAL PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 HIGHWAY 1
THIBODAUX LA
70301-5843
US

IV. Provider business mailing address

2590 HIGHWAY 1
THIBODAUX LA
70301-5843
US

V. Phone/Fax

Practice location:
  • Phone: 985-313-1093
  • Fax: 985-313-1092
Mailing address:
  • Phone: 985-313-1093
  • Fax: 985-313-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC11094
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: