Provider Demographics
NPI:1548079338
Name:MATTHEWS, TASSANY NICOLE
Entity type:Individual
Prefix:MISS
First Name:TASSANY
Middle Name:NICOLE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S ANDREW ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-5702
Mailing Address - Country:US
Mailing Address - Phone:337-388-1252
Mailing Address - Fax:
Practice Address - Street 1:106 S ANDREW ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-5702
Practice Address - Country:US
Practice Address - Phone:337-388-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)