Provider Demographics
NPI:1386373363
Name:REINE, TAJA SHANTELL (FNP-C)
Entity type:Individual
Prefix:
First Name:TAJA
Middle Name:SHANTELL
Last Name:REINE
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 1:2245 KING ARTHUR BLVD APT 6
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2468
Mailing Address - Country:US
Mailing Address - Phone:985-226-3100
Mailing Address - Fax:
Practice Address - Street 1:1780 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2352
Practice Address - Country:US
Practice Address - Phone:504-910-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA219731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily