Healthcare Provider Details

I. General information

NPI: 1295659852
Provider Name (Legal Business Name): JENNIFER FORSHAG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD STE 303
LAFAYETTE LA
70503-2636
US

IV. Provider business mailing address

206 RUE SAINT BARTS
YOUNGSVILLE LA
70592-5525
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-6697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number247285
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: