Provider Demographics
NPI:1437425493
Name:FUENZALIDA, PATRICIA (ANP-C)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:FUENZALIDA
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GERI CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2103
Mailing Address - Country:US
Mailing Address - Phone:504-914-2011
Mailing Address - Fax:
Practice Address - Street 1:10 GERI CT
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-2103
Practice Address - Country:US
Practice Address - Phone:504-914-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO6595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health