Individual
TUNYA S. JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1241 SHADYBROOK DR, BATON ROUGE, LA 70816-1273
(225) 485-1797
Mailing address
1241 SHADYBROOK DR, BATON ROUGE, LA 70816-1273
(225) 485-1797
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
204007
LA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1077321
TX
Other
Enumeration date
03/04/2019
Last updated
12/11/2024
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