Provider Demographics
NPI:1083159040
Name:TAYLOR, NICOLE DEJEAN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DEJEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:AMANDA
Other - Last Name:DEJEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 MARK TWAIN DR
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2488
Mailing Address - Country:US
Mailing Address - Phone:504-610-1490
Mailing Address - Fax:
Practice Address - Street 1:220 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:504-896-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN117994163W00000X
LAAP09056363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse