Provider Demographics
NPI:1790283984
Name:TOLBERT, TRAKISSIA (FNP)
Entity Type:Individual
Prefix:
First Name:TRAKISSIA
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-2746
Mailing Address - Country:US
Mailing Address - Phone:225-227-2998
Mailing Address - Fax:
Practice Address - Street 1:3535 RILEY ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-2746
Practice Address - Country:US
Practice Address - Phone:225-227-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily