Provider Demographics
NPI:1154838241
Name:MILL, TRACY DANIELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:DANIELLE
Last Name:MILL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20102 QUICKTIME CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-1972
Mailing Address - Country:US
Mailing Address - Phone:713-261-7388
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH STREET SUITE 1B350S
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0001
Practice Address - Country:US
Practice Address - Phone:806-743-6639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692258367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered