Provider Demographics
NPI:1215310453
Name:BROUSSARD, JORDAN STEIN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:STEIN
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:LEIGH
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3301 OLD SPANISH TRAIL
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:LA
Mailing Address - Zip Code:70669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 OLD SPANISH TRAIL
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:LA
Practice Address - Zip Code:70669
Practice Address - Country:US
Practice Address - Phone:337-532-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8399363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health