Provider Demographics
NPI:1801289624
Name:ROBERT, THERESA ESCUDE' (APRN, CPNP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ESCUDE'
Last Name:ROBERT
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 1:12454 FERNAND RD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6180
Mailing Address - Country:US
Mailing Address - Phone:225-964-5596
Mailing Address - Fax:
Practice Address - Street 1:7278 HIGHLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-6600
Practice Address - Country:US
Practice Address - Phone:225-367-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07745363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics