Provider Demographics
NPI:1396231726
Name:COSTER, JACQUELYN LEANNA (ACNP-AG)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:LEANNA
Last Name:COSTER
Suffix:
Gender:F
Credentials:ACNP-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 DUNN ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4440
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-876-5529
Practice Address - Street 1:225 DUNN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4440
Practice Address - Country:US
Practice Address - Phone:985-876-0300
Practice Address - Fax:985-876-5529
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10020363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care