Provider Demographics
NPI:1164793394
Name:GARZA, TRACY DAWN (LPT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:DAWN
Last Name:GARZA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12621 ZUNI ST APT 17-102
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3806
Mailing Address - Country:US
Mailing Address - Phone:719-924-2443
Mailing Address - Fax:
Practice Address - Street 1:12621 ZUNI ST APT 17-102
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-3806
Practice Address - Country:US
Practice Address - Phone:719-924-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMI-4601167G00000X
CONA-365660376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No376K00000XNursing Service Related ProvidersNurse's Aide