Healthcare Provider Details

I. General information

NPI: 1265409080
Provider Name (Legal Business Name): JODI VINCENSFNP-BC BURAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GREENBRIER BLVD
COVINGTON LA
70433-7233
US

IV. Provider business mailing address

160 GREENBRIER BLVD
COVINGTON LA
70433-7233
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-5780
  • Fax: 985-893-0601
Mailing address:
  • Phone: 985-893-5780
  • Fax: 985-893-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP03852
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: