Healthcare Provider Details

I. General information

NPI: 1821098450
Provider Name (Legal Business Name): JEANETTE ELLEN HOTARD CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANETTE HOTARD PRISCO CFNP

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 11/19/2022
Certification Date: 11/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 LUTCHER AVE
LUTCHER LA
70071-5151
US

IV. Provider business mailing address

12 MUIRFIELD DR
LA PLACE LA
70068-1632
US

V. Phone/Fax

Practice location:
  • Phone: 225-258-2040
  • Fax:
Mailing address:
  • Phone: 504-259-6663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP03912
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN067828 AP03912
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: