Provider Demographics
NPI:1992990626
Name:LABARRE, TAMMI C (NP)
Entity type:Individual
Prefix:MRS
First Name:TAMMI
Middle Name:C
Last Name:LABARRE
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:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-1234
Mailing Address - Country:US
Mailing Address - Phone:504-982-0146
Mailing Address - Fax:
Practice Address - Street 1:330 OAK HARBOR BLVD STE D
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-326-1140
Practice Address - Fax:985-214-9540
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1150738Medicaid
LA19D1083407OtherCLIA CERTIFICATE OF WAIVER
LA3A674DD86Medicare PIN