Healthcare Provider Details

I. General information

NPI: 1619970308
Provider Name (Legal Business Name): TRACY P BROUSSARD F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8762 HIGHWAY 182
OPELOUSAS LA
70570-5603
US

IV. Provider business mailing address

8762 HIGHWAY 182
OPELOUSAS LA
70570-5603
US

V. Phone/Fax

Practice location:
  • Phone: 337-942-2005
  • Fax: 337-942-9736
Mailing address:
  • Phone: 337-942-2005
  • Fax: 337-942-9736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN087132 AP04548
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: