Healthcare Provider Details

I. General information

NPI: 1225291230
Provider Name (Legal Business Name): TARA WHITTAKER JOCHUM APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA WHITTAKER DODD APRN, FP-C

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 11/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 GAUSE BLVD E ST 101
SLIDELL LA
70461-5442
US

IV. Provider business mailing address

3838 N CAUSEWAY BLVD STE 2200
METAIRIE LA
70002-8306
US

V. Phone/Fax

Practice location:
  • Phone: 985-634-3909
  • Fax:
Mailing address:
  • Phone: 504-849-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1893
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: