Provider Demographics
NPI:1215284963
Name:NAQUIN, JEANETTE L (FNP-C)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:L
Last Name:NAQUIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4051
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4051
Mailing Address - Country:US
Mailing Address - Phone:985-917-3007
Mailing Address - Fax:985-917-3010
Practice Address - Street 1:128 NEUROSCIENCE CT
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-5209
Practice Address - Country:US
Practice Address - Phone:985-917-3007
Practice Address - Fax:985-917-3010
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2348132Medicaid
LA2348132Medicaid