Provider Demographics
NPI:1699930719
Name:TIFFANY ROY, FNP, L.L.C.
Entity type:Organization
Organization Name:TIFFANY ROY, FNP, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:337-873-8244
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:DUSON
Mailing Address - State:LA
Mailing Address - Zip Code:70529-0370
Mailing Address - Country:US
Mailing Address - Phone:337-873-8244
Mailing Address - Fax:337-873-8274
Practice Address - Street 1:110 W. FIRST ST
Practice Address - Street 2:SUITE A
Practice Address - City:DUSON
Practice Address - State:LA
Practice Address - Zip Code:70529
Practice Address - Country:US
Practice Address - Phone:337-873-8244
Practice Address - Fax:337-873-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04568261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DF41OtherMEDICARE
LA1592919Medicaid