Individual
MRS. JOAN T. BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.C.N.P.
Contact information
Practice address
917 COOLIDGE BLVD, LAFAYETTE, LA 70503-2433
(337) 237-5774
(337) 237-4939
Mailing address
457 HEYMANN BLVD, LAFAYETTE, LA 70503-2616
(337) 237-5774
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN083622
LA
363LA2100X
Acute Care Nurse Practitioner
Primary
AP05141
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1408361
—
LA
01
—
AP05141
STATE LICENSE
LA
Enumeration date
01/10/2007
Last updated
08/24/2021
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