Provider Demographics
NPI:1013045624
Name:COCO, MARSHALL QUINN (NP)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:QUINN
Last Name:COCO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5939
Mailing Address - Country:US
Mailing Address - Phone:337-988-1585
Mailing Address - Fax:337-981-4694
Practice Address - Street 1:2730 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5904
Practice Address - Country:US
Practice Address - Phone:337-988-1585
Practice Address - Fax:337-988-1586
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN081153 -AP05151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1008176Medicaid
LA1008176Medicaid
LAQ77192Medicare UPIN
LA1008176Medicaid