Provider Demographics
NPI:1124327630
Name:JURACOVICH, JANET RUTH (ANP-BC)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:RUTH
Last Name:JURACOVICH
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:RUTH
Other - Last Name:JURACOVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:121 RUE LOUIS XIV BLDG 4
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5738
Mailing Address - Country:US
Mailing Address - Phone:337-984-9355
Mailing Address - Fax:337-984-9592
Practice Address - Street 1:121 RUE LOUIS XIV BLDG 4
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5738
Practice Address - Country:US
Practice Address - Phone:337-984-9355
Practice Address - Fax:337-984-9592
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN063196-AP06340363LA2200X
LARN063196163W00000X
LAAP06340363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2196391Medicaid