Healthcare Provider Details

I. General information

NPI: 1275974776
Provider Name (Legal Business Name): JENNIFER N SCIACCA C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8212 SUMMA AVE
BATON ROUGE LA
70809-3421
US

IV. Provider business mailing address

7777 HENNESSY BLVD STE 301
BATON ROUGE LA
70808-0319
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-4403
  • Fax:
Mailing address:
  • Phone: 225-769-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP07337
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: