Provider Demographics
NPI:1992983043
Name:TIGERT, NANCY K (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:TIGERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5210
Mailing Address - Country:US
Mailing Address - Phone:504-887-1133
Mailing Address - Fax:
Practice Address - Street 1:4901 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5210
Practice Address - Country:US
Practice Address - Phone:504-887-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02709363LP0200X
LARN084247363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1535923Medicaid
MS04226283Medicaid
LA5X592Medicare PIN