Provider Demographics
NPI:1548661440
Name:TERRELL, TIFFANY ALYCE (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ALYCE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ALYCE
Other - Last Name:ROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:820 JORDAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4518
Mailing Address - Country:US
Mailing Address - Phone:318-221-0399
Mailing Address - Fax:318-221-1940
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4518
Practice Address - Country:US
Practice Address - Phone:318-221-0399
Practice Address - Fax:318-221-1940
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily