Provider Demographics
NPI:1760867626
Name:NAQUIN, MATTHEW CHARLES (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CHARLES
Last Name:NAQUIN
Suffix:
Gender:M
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 1:10059 N REIGER RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-4559
Mailing Address - Country:US
Mailing Address - Phone:225-756-2673
Mailing Address - Fax:
Practice Address - Street 1:10059 N REIGER RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4559
Practice Address - Country:US
Practice Address - Phone:225-756-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2425889Medicaid
MS05204870Medicaid
LA2425889Medicaid