Provider Demographics
NPI:1962154062
Name:LAFONTAINE, ANGELA NICOLE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:NICOLE
Last Name:LAFONTAINE
Suffix:
Gender:F
Credentials:MSN, 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 1:64301 HIGHWAY 434
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-5411
Mailing Address - Country:US
Mailing Address - Phone:985-882-4500
Mailing Address - Fax:
Practice Address - Street 1:985 ROBERT BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2063
Practice Address - Country:US
Practice Address - Phone:985-661-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F07211303OtherAANP CERTIFICATION #