Provider Demographics
NPI:1669504379
Name:BROCKHOEFT, JACQUELINE (CRNA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BROCKHOEFT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 SEVERN AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5932
Mailing Address - Country:US
Mailing Address - Phone:504-832-4200
Mailing Address - Fax:504-378-5121
Practice Address - Street 1:2525 SEVERN AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5932
Practice Address - Country:US
Practice Address - Phone:504-832-4200
Practice Address - Fax:504-378-5121
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN059884 AP04027367500000X
LARN059884163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse