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Individual

TIFFANY VINCENT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
10101 PARK ROWE AVE, STE. 200, BATON ROUGE, LA 70810-1686
(225) 769-2200
(225) 768-2185
Mailing address
PO BOX 98509, BATON ROUGE, LA 70884-9509
(225) 769-2200
(225) 768-2185

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200851
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
200851
PA LICENSE NUMBER
LA
05
2401211
LA
Enumeration date
08/12/2015
Last updated
10/02/2015
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