Provider Demographics
NPI:1164678694
Name:MAESTRINI, TRACY ANNE (NP)
Entity Type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:ANNE
Last Name:MAESTRINI
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 1:1700 ROGERS RD APT 155
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-8610
Mailing Address - Country:US
Mailing Address - Phone:310-977-0552
Mailing Address - Fax:
Practice Address - Street 1:203 WALLS DR STE 203
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7029
Practice Address - Country:US
Practice Address - Phone:817-517-5756
Practice Address - Fax:817-556-9105
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18403363LA2100X, 363L00000X
TXAP128299363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX440247YKPWMedicare PIN
CACW369ZMedicare PIN
TX440247YKP5Medicare PIN