MEDICARE: TIFFANY M ETIENNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1285597104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY M ETIENNE

Provider Business Mailing Address
First Line	:	1010 FIELD ST
Second Line	:
City	:	WESTLAKE
State	:	LA
Zip	:	70669-5202
Country	:	US
Telephone Number	:	337-660-6188
Fax Number	:

Provider Business Practice Location Address
First Line	:	184 WILLIAMSBURG ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5720
Country	:	US
Telephone Number	:	337-437-4014
Fax Number	:	337-437-8283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ TIFFANY M ETIENNE ” Practice Location

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