Healthcare Provider Details

I. General information

NPI: 1578743811
Provider Name (Legal Business Name): JILL AILEEN FITZPATRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JUDGE TANNER BLVD. #302
COVINGTON LA
70433-7506
US

IV. Provider business mailing address

1514 JEFFERSON HIGHWAY
NEW ORLEANS LA
70121
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-5800
  • Fax:
Mailing address:
  • Phone: 504-842-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.203185
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: