Provider Demographics
NPI:1396057543
Name:POE, TRAVIS VINCENT (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:VINCENT
Last Name:POE
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 BREN ROAD EAST
Mailing Address - Street 2:MAIL ROUTE MN 008-B213
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-3827
Mailing Address - Country:US
Mailing Address - Phone:832-906-1921
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:832-906-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-03
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily