Healthcare Provider Details

I. General information

NPI: 1487697199
Provider Name (Legal Business Name): TONYA JAGNEAUX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE STE 313
BATON ROUGE LA
70809
US

IV. Provider business mailing address

PO BOX 919237
DALLAS TX
75391-9237
US

V. Phone/Fax

Practice location:
  • Phone: 225-381-2755
  • Fax: 225-381-2759
Mailing address:
  • Phone: 225-381-2755
  • Fax: 225-381-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number024261
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number024261
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: