MEDICARE: JACOB ROBERT RICKOLL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	214020	LA
2	363LP2300X	Primary Care Nurse Practitioner	214020	LA

General Provider Information

NPI Number	:	1225665417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ROBERT RICKOLL NP

Provider Business Mailing Address
First Line	:	3637 CANAL ST STE 100
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6110
Country	:	US
Telephone Number	:	504-613-0315
Fax Number	:	888-498-4941

Provider Business Practice Location Address
First Line	:	3637 CANAL ST STE 100
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-6110
Country	:	US
Telephone Number	:	504-613-0315
Fax Number	:	888-498-4941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	01/15/2026

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