Provider Demographics
NPI:1578794046
Name:LACAZE, KRISTINA SMITH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:SMITH
Last Name:LACAZE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1819
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-1819
Mailing Address - Country:US
Mailing Address - Phone:504-340-6711
Mailing Address - Fax:504-348-3935
Practice Address - Street 1:712 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:WESTWEGO
Practice Address - State:LA
Practice Address - Zip Code:70094-4400
Practice Address - Country:US
Practice Address - Phone:504-340-7744
Practice Address - Fax:504-340-7920
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN100970 AP05889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily