Provider Demographics
NPI:1306490925
Name:LOUIS-JACQUES, OLIVIA (NP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:LOUIS-JACQUES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4026
Mailing Address - Country:US
Mailing Address - Phone:718-644-0743
Mailing Address - Fax:
Practice Address - Street 1:329 E MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2831
Practice Address - Country:US
Practice Address - Phone:631-366-2333
Practice Address - Fax:631-366-1211
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily