Provider Demographics
NPI:1659510147
Name:ROLLINS, JEREMY TODD (FNP)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:TODD
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 HIGHWAY 3210
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:LA
Mailing Address - Zip Code:71336-5833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3326 FRONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-6487
Practice Address - Country:US
Practice Address - Phone:318-425-7333
Practice Address - Fax:318-435-9061
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily