Provider Demographics
NPI:1487837985
Name:SMART, ANTIQUA NICOLE (APRN-CNP)
Entity Type:Individual
Prefix:MS
First Name:ANTIQUA
Middle Name:NICOLE
Last Name:SMART
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 LOWER ZACHARY RD
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-5328
Mailing Address - Country:US
Mailing Address - Phone:225-937-7491
Mailing Address - Fax:
Practice Address - Street 1:9118 BLUEBONNET CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2975
Practice Address - Country:US
Practice Address - Phone:225-368-2300
Practice Address - Fax:225-368-2280
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05288363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP05288OtherAPRN