Healthcare Provider Details

I. General information

NPI: 1255393807
Provider Name (Legal Business Name): BOBBI MARINO CALDWELL MSN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

301 EDGEHILL CIRCLE
LAFAYETTE LA
70508-5625
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-7782
  • Fax:
Mailing address:
  • Phone: 337-234-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number665217
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAP05120
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: