Provider Demographics
NPI:1093341380
Name:VACCARO-MUSSEHL, TIA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:MARIE
Last Name:VACCARO-MUSSEHL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 LAURA LN STE 130
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-1872
Mailing Address - Country:US
Mailing Address - Phone:888-688-4746
Mailing Address - Fax:
Practice Address - Street 1:3030 LAURA LN STE 130
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-1872
Practice Address - Country:US
Practice Address - Phone:888-688-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIF01201947207Q00000X
WI10116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine