Provider Demographics
NPI:1821098450
Name:HOTARD, JEANETTE ELLEN (CFNP)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:ELLEN
Last Name:HOTARD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:MRS
Other - First Name:JEANETTE
Other - Middle Name:HOTARD
Other - Last Name:PRISCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:12 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-1632
Mailing Address - Country:US
Mailing Address - Phone:504-259-6663
Mailing Address - Fax:
Practice Address - Street 1:1731 LUTCHER AVE
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5151
Practice Address - Country:US
Practice Address - Phone:225-258-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03912363LF0000X
LARN067828 AP03912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1106283Medicaid
LA1106283Medicaid
LAP40754Medicare UPIN