Provider Demographics
NPI:1548840945
Name:BERGERON, TIFFANEY (RN)
Entity type:Individual
Prefix:
First Name:TIFFANEY
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 BARRON ST STE C210
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5798
Mailing Address - Country:US
Mailing Address - Phone:504-887-3142
Mailing Address - Fax:504-887-3145
Practice Address - Street 1:3926 BARRON ST STE C210
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5798
Practice Address - Country:US
Practice Address - Phone:504-887-3142
Practice Address - Fax:504-887-3145
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN085616163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care