Provider Demographics
NPI:1144993437
Name:FORSTALL, JENNIFER RENAE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENAE
Last Name:FORSTALL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 TULANE AVE DEPT ROOM8622
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-2317
Mailing Address - Fax:504-988-5262
Practice Address - Street 1:4320 HOUMA BLVD STE 700
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2673
Practice Address - Country:US
Practice Address - Phone:504-988-5344
Practice Address - Fax:504-988-5262
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily