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:
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Other - Credentials:
Mailing Address - Street 1:5525 SUPERIOR DR STE C3
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8052
Mailing Address - Country:US
Mailing Address - Phone:225-413-2265
Mailing Address - Fax:225-217-8899
Practice Address - Street 1:5525 SUPERIOR DR STE C3
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8052
Practice Address - Country:US
Practice Address - Phone:225-496-1921
Practice Address - Fax:225-217-8899
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2024-12-09
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