Healthcare Provider Details

I. General information

NPI: 1942379649
Provider Name (Legal Business Name): JOE C FLORICE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/06/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 NEWTON ST
SAINT JOSEPH LA
71366-4330
US

IV. Provider business mailing address

PO BOX 1300
WINNSBORO LA
71295-1300
US

V. Phone/Fax

Practice location:
  • Phone: 318-766-8506
  • Fax: 318-435-7458
Mailing address:
  • Phone: 318-435-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP05075
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: