Provider Demographics
NPI:1083249700
Name:SEDANO, TRACY ERIK (APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:ERIK
Last Name:SEDANO
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 LASALETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5632
Mailing Address - Country:US
Mailing Address - Phone:337-540-4934
Mailing Address - Fax:
Practice Address - Street 1:2640 COUNTRY CLUB RD STE 400
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-6079
Practice Address - Country:US
Practice Address - Phone:337-426-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily