Provider Demographics
NPI:1760738801
Name:GEORGE, TIFFANY (NP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7860 OAK CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-8811
Mailing Address - Country:US
Mailing Address - Phone:318-425-9965
Mailing Address - Fax:318-828-2521
Practice Address - Street 1:7505 PINES RD STE 1100
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3900
Practice Address - Country:US
Practice Address - Phone:318-425-9965
Practice Address - Fax:318-828-2521
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2025-04-03
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Provider Licenses
StateLicense IDTaxonomies
LAAP07008363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health