Provider Demographics
NPI:1336453794
Name:SOILEAU, JILLIAN VIDRINE (APRN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:VIDRINE
Last Name:SOILEAU
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-6542
Mailing Address - Country:US
Mailing Address - Phone:337-407-2795
Mailing Address - Fax:337-407-2798
Practice Address - Street 1:3501 HIGHWAY 190 STE T
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5129
Practice Address - Country:US
Practice Address - Phone:337-457-8980
Practice Address - Fax:337-457-8983
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06203363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics