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NPI Code Detail

MEDICARE: TINA MARIE BOUDREAUX FNP

MEDICARE: TINA MARIE BOUDREAUX FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN101634AP04563LA

General Provider Information

NPI Number : 1568468353
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA MARIE BOUDREAUX FNP
Provider Business Mailing Address
First Line : 2390 W CONGRESS ST
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-4205
Country : US
Telephone Number : 337-261-6100
Fax Number : 337-261-6102
Provider Business Practice Location Address
First Line : 2390 W CONGRESS ST
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-4205
Country : US
Telephone Number : 337-261-6100
Fax Number : 337-261-6102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2005
Last Update Date : 07/27/2016

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Directions to “ TINA MARIE BOUDREAUX FNP” Practice Location

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