Provider Demographics
NPI:1780703710
Name:JAUBERT, LISA ANN (ANP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:JAUBERT
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 NORTH DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4042
Mailing Address - Country:US
Mailing Address - Phone:337-898-1860
Mailing Address - Fax:337-898-1862
Practice Address - Street 1:2621 NORTH DR
Practice Address - Street 2:SUITE B
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4042
Practice Address - Country:US
Practice Address - Phone:337-898-1860
Practice Address - Fax:337-898-1862
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN066949 AP05153363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1010944Medicaid
LA3A224CX68Medicare PIN
LAQ79504Medicare UPIN