Provider Demographics
NPI:1588949341
Name:MATTIO, TRACEY RENEE (FNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:RENEE
Last Name:MATTIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4124
Mailing Address - Country:US
Mailing Address - Phone:337-828-2550
Mailing Address - Fax:337-355-2335
Practice Address - Street 1:159 E 3RD ST
Practice Address - Street 2:
Practice Address - City:EDGARD
Practice Address - State:LA
Practice Address - Zip Code:70049-2450
Practice Address - Country:US
Practice Address - Phone:985-497-8726
Practice Address - Fax:985-497-3108
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily