Provider Demographics
NPI:1598019978
Name:BREAUX, JILL ANGELLE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANGELLE
Last Name:BREAUX
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 ELTON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4100
Mailing Address - Country:US
Mailing Address - Phone:337-824-8868
Mailing Address - Fax:337-824-8840
Practice Address - Street 1:1322 ELTON RD
Practice Address - Street 2:SUITE F
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4100
Practice Address - Country:US
Practice Address - Phone:337-824-8868
Practice Address - Fax:337-824-8840
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07103363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2327500Medicaid
LA260938YJ8UMedicare PIN