Healthcare Provider Details

I. General information

NPI: 1205517638
Provider Name (Legal Business Name): JASMINE SHANIKQUA SAVOIE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 POINCIANA AVE
MAMOU LA
70554-2201
US

IV. Provider business mailing address

219 BERTRAND RD
OPELOUSAS LA
70570-1922
US

V. Phone/Fax

Practice location:
  • Phone: 337-468-3099
  • Fax: 337-468-3083
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number231920
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: