Provider Demographics
NPI:1730328931
Name:DOGGETT, TINA STAFFORD (NP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:STAFFORD
Last Name:DOGGETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:A
Other - Last Name:THIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:211 4TH ST
Mailing Address - Street 2:BOX 30101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8421
Mailing Address - Country:US
Mailing Address - Phone:318-769-7160
Mailing Address - Fax:318-769-7473
Practice Address - Street 1:501 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8124
Practice Address - Country:US
Practice Address - Phone:318-769-7160
Practice Address - Fax:318-769-7473
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN085762163W00000X
LAAP04352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse