Healthcare Provider Details

I. General information

NPI: 1487837985
Provider Name (Legal Business Name): ANTIQUA NICOLE SMART APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 ONEAL LN # 109
BATON ROUGE LA
70816-1633
US

IV. Provider business mailing address

5811 LOWER ZACHARY RD
ZACHARY LA
70791-5328
US

V. Phone/Fax

Practice location:
  • Phone: 225-308-1326
  • Fax:
Mailing address:
  • Phone: 225-937-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP05288
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP05288
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: