Healthcare Provider Details

I. General information

NPI: 1306220728
Provider Name (Legal Business Name): GINA RANCATORE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA RANCATORE NELSON FNP

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 ROBERT BLVD STE 104
SLIDELL LA
70458-2063
US

IV. Provider business mailing address

64301 HIGHWAY 434
LACOMBE LA
70445-5411
US

V. Phone/Fax

Practice location:
  • Phone: 985-882-4500
  • Fax:
Mailing address:
  • Phone: 985-882-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08319
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: