Provider Demographics
NPI:1134467079
Name:SCHRUFF, SHANE ANTHONY (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:ANTHONY
Last Name:SCHRUFF
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73589 HIGHWAY 437
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-6159
Mailing Address - Country:US
Mailing Address - Phone:504-388-3249
Mailing Address - Fax:
Practice Address - Street 1:3348 W ESPLANADE AVE S
Practice Address - Street 2:SUITE A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3475
Practice Address - Country:US
Practice Address - Phone:504-455-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07148OtherLOUISIANA STATE BOARD OF NURSING, ADVANCED PRACTICE REGISTERED NURSE
F1112162OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS