Healthcare Provider Details

I. General information

NPI: 1265735757
Provider Name (Legal Business Name): JILL ELIZABETH LEBLANC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ELIZABETH SMITH NP

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 MAGNOLIA CV
MONROE LA
71203-2375
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-5400
  • Fax: 318-966-5401
Mailing address:
  • Phone: 318-966-5400
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN1018061
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP011091
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number203897
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: