Provider Demographics
NPI:1790478089
Name:SMITH, MARQUITA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3121
Mailing Address - Country:US
Mailing Address - Phone:225-202-9278
Mailing Address - Fax:
Practice Address - Street 1:4451 LOUISIANA HWY 1 SOUTH, STE. 5
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767
Practice Address - Country:US
Practice Address - Phone:225-763-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN149102363LP2300X
LA231758363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care