Provider Demographics
NPI:1538305800
Name:HUFFSTATLER, TRACY LYTLE (APN, RN, ACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYTLE
Last Name:HUFFSTATLER
Suffix:
Gender:F
Credentials:APN, RN, ACNP-BC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYTLE
Other - Last Name:SADDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4914 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-2839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4914 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:DEFOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-2839
Practice Address - Country:US
Practice Address - Phone:901-552-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13849363LA2100X
WI22889363LA2100X
WI13915-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care