Provider Demographics
NPI:1235597030
Name:VAANDRAGER, TRACEY BRIZENDINE (COM)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:BRIZENDINE
Last Name:VAANDRAGER
Suffix:
Gender:F
Credentials:COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BRIZENDINE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4987
Mailing Address - Country:US
Mailing Address - Phone:737-247-6960
Mailing Address - Fax:512-419-1708
Practice Address - Street 1:701 BRIZENDINE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4987
Practice Address - Country:US
Practice Address - Phone:737-247-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist