Provider Demographics
NPI:1417505090
Name:BROCATO, JENNIFER KAY
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:BROCATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2761 CROWN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-8135
Mailing Address - Country:US
Mailing Address - Phone:337-274-9563
Mailing Address - Fax:
Practice Address - Street 1:2761 CROWN LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-8135
Practice Address - Country:US
Practice Address - Phone:337-274-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker