Provider Demographics
NPI:1104126846
Name:CAGNOLATTI, ELIZABETH MARIE (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:CAGNOLATTI
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BOULEVARD OF THE AMERICAS SUITE 503
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-967-2635
Mailing Address - Fax:504-218-4607
Practice Address - Street 1:4933 WABASH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1031
Practice Address - Country:US
Practice Address - Phone:504-780-2766
Practice Address - Fax:504-308-3283
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2131516Medicaid
LA2131516Medicaid