Provider Demographics
NPI:1427329044
Name:THIBODEAUX, SUNNY Q (NURSE PRACTIONIER)
Entity type:Individual
Prefix:MRS
First Name:SUNNY
Middle Name:Q
Last Name:THIBODEAUX
Suffix:
Gender:F
Credentials:NURSE PRACTIONIER
Other - Prefix:MRS
Other - First Name:SUNNY
Other - Middle Name:Q
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTIONIER
Mailing Address - Street 1:1060 PEERLESS XING NW STE 101
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3784
Mailing Address - Country:US
Mailing Address - Phone:423-479-4165
Mailing Address - Fax:423-478-1884
Practice Address - Street 1:1060 PEERLESS XING NW STE 101
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-479-4165
Practice Address - Fax:423-478-1884
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN19160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily