Provider Demographics
NPI:1972363547
Name:COLLINS-JACKSON, EVOICA RENEE (DVM, CERTIFIED DOULA)
Entity Type:Individual
Prefix:
First Name:EVOICA
Middle Name:RENEE
Last Name:COLLINS-JACKSON
Suffix:
Gender:F
Credentials:DVM, CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9388 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-4432
Mailing Address - Country:US
Mailing Address - Phone:225-200-9221
Mailing Address - Fax:
Practice Address - Street 1:9388 HOOPER RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-4432
Practice Address - Country:US
Practice Address - Phone:225-200-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula