Provider Demographics
NPI:1003394792
Name:TAYLOR, TRACY DEE (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:DEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 BLUE STEM APT 24106
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1777
Mailing Address - Country:US
Mailing Address - Phone:469-816-1846
Mailing Address - Fax:
Practice Address - Street 1:4500 BLUE STEM APT 24106
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-1777
Practice Address - Country:US
Practice Address - Phone:469-816-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680771163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health