Healthcare Provider Details

I. General information

NPI: 1063458966
Provider Name (Legal Business Name): HOLLY DAQUANA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 INDUSTRIAL BOULEVARD
HOUMA LA
70363-7055
US

IV. Provider business mailing address

1990 INDUSTRIAL BOULEVARD
HOUMA LA
70363-7055
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-9300
  • Fax: 985-851-0053
Mailing address:
  • Phone: 985-868-9300
  • Fax: 985-851-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04301
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: