Healthcare Provider Details

I. General information

NPI: 1114897824
Provider Name (Legal Business Name): MONICA RUBY CONIGLIO FNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 HEAVENS DR
MANDEVILLE LA
70471-2890
US

IV. Provider business mailing address

804 HEAVENS DR
MANDEVILLE LA
70471-2890
US

V. Phone/Fax

Practice location:
  • Phone: 985-900-2400
  • Fax:
Mailing address:
  • Phone: 985-900-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number243234
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: