Provider Demographics
NPI:1235639964
Name:FORD, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 CRESCENT OAKS PARK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3367
Mailing Address - Country:US
Mailing Address - Phone:832-928-4159
Mailing Address - Fax:
Practice Address - Street 1:3107 CRESCENT OAKS PARK LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-3367
Practice Address - Country:US
Practice Address - Phone:832-928-4159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant