Provider Demographics
NPI:1083477814
Name:NOLA CARE
Entity Type:Organization
Organization Name:NOLA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-237-7908
Mailing Address - Street 1:14367 DURBIN ISLAND WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7095
Mailing Address - Country:US
Mailing Address - Phone:504-237-7908
Mailing Address - Fax:
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 505
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5213
Practice Address - Country:US
Practice Address - Phone:905-701-3610
Practice Address - Fax:904-339-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty