Basic Information
| Provider Information | |||||||||
| NPI: | 1891216321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDICE | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W PINHOOK RD STE 301 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372641011 | ||||||||
| FaxNumber: | 3372641211 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 AMBASSADOR CAFFERY PKWY | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705086917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374702017 | ||||||||
| FaxNumber: | 3374702809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP09439 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | AP09439 | 01 | LA | NURSE PRACTITIONER LICENSE | OTHER |