Provider Demographics
NPI:1336416502
Name:PHILLIPS, TANIA L
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:T
Other - Last Name:PHILLIPS
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70059-1484
Mailing Address - Country:US
Mailing Address - Phone:504-292-3831
Mailing Address - Fax:504-348-1168
Practice Address - Street 1:2072 SUSSEX ST
Practice Address - Street 2:STE104
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5903
Practice Address - Country:US
Practice Address - Phone:504-292-3831
Practice Address - Fax:504-348-1168
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care