MEDICARE: TIFFANY N CAVALIER FNP

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	363L00000X	Nurse Practitioner	F06231776	LA
2	207Q00000X	Family Medicine Physician	F06231776	LA

General Provider Information

NPI Number	:	1578244828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY N CAVALIER FNP

Provider Business Mailing Address
First Line	:	8907 REDWOOD LAKE BLVD
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-8341
Country	:	US
Telephone Number	:	225-620-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	8907 REDWOOD LAKE BLVD
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-8341
Country	:	US
Telephone Number	:	225-620-3390
Fax Number	:

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

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	08/07/2023

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