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NPI Code Detail

MEDICARE: TRACY P BROUSSARD F.N.P.

MEDICARE: TRACY P BROUSSARD F.N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN087132 AP04548LA

General Provider Information

NPI Number : 1619970308
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY P BROUSSARD F.N.P.
Provider Business Mailing Address
First Line : 8762 HIGHWAY 182
Second Line :
City : OPELOUSAS
State : LA
Zip : 70570-5603
Country : US
Telephone Number : 337-942-2005
Fax Number : 337-942-9736
Provider Business Practice Location Address
First Line : 8762 HIGHWAY 182
Second Line :
City : OPELOUSAS
State : LA
Zip : 70570-5603
Country : US
Telephone Number : 337-942-2005
Fax Number : 337-942-9736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 11/18/2025

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