Provider Demographics
NPI:1033794052
Name:BUSTILLO, ERICA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:BUSTILLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BEAUREGARD DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-4853
Mailing Address - Country:US
Mailing Address - Phone:504-388-7962
Mailing Address - Fax:
Practice Address - Street 1:3600 PRYTANIA ST STE 35
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3678
Practice Address - Country:US
Practice Address - Phone:504-897-7197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily