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General NPI Number Information
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NPI Number | 1750895702
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Entity Type | Individual
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Provider Name | TIFFANY O'NEAL APRN
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Gender | Female
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 9435 MANSFIELD RD
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City | SHREVEPORT
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State | LA
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Zip | 71118-3859
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Country | US
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Telephone | 318-686-3770
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Fax |
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Provider Business Mailing Address
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Address Line | 3662 BELLAIRE AVE
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City | SHREVEPORT
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State | LA
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Zip | 71109-1706
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Country | US
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Telephone | 318-990-6606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP09323
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License Number State | LA
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