Provider Demographics
NPI:1407322878
Name:NAZAR, MARIA ANGELICA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:NAZAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 SAINT ANN DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1651
Mailing Address - Country:US
Mailing Address - Phone:504-338-7748
Mailing Address - Fax:
Practice Address - Street 1:4315 HOUMA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2942
Practice Address - Country:US
Practice Address - Phone:504-889-5250
Practice Address - Fax:504-889-5248
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA312952363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2515144Medicaid