Healthcare Provider Details

I. General information

NPI: 1578218020
Provider Name (Legal Business Name): HOLLY ROSE OQUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S CLEARVIEW PKWY
NEW ORLEANS LA
70121-1011
US

IV. Provider business mailing address

140 CITRUS RD
RIVER RIDGE LA
70123-2504
US

V. Phone/Fax

Practice location:
  • Phone: 504-703-3809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number100872
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22620
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: