Provider Demographics
NPI:1124574298
Name:MACIEL, TRACEY ARLENE (NP)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ARLENE
Last Name:MACIEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 JAIME ZAPATA MEMORIAL HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4770
Mailing Address - Country:US
Mailing Address - Phone:956-726-9252
Mailing Address - Fax:956-753-3442
Practice Address - Street 1:801 N US HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076-3290
Practice Address - Country:US
Practice Address - Phone:956-765-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158072203Medicaid
TX158072201Medicaid
TX158072202Medicaid