MEDICARE: OLIVIA LOUIS-JACQUES 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	363LF0000X	Family Nurse Practitioner	344905	NY

General Provider Information

NPI Number	:	1306490925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA LOUIS-JACQUES NP

Provider Business Mailing Address
First Line	:	329 E MAIN ST
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2830
Country	:	US
Telephone Number	:	718-644-0743
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 OHIO DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1144
Country	:	US
Telephone Number	:	516-519-8260
Fax Number	:

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

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	12/12/2025

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