Provider Demographics
NPI:1417424219
Name:JULIEN, TRACY (FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:JULIEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E ABRAM ST STE 208
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-1200
Mailing Address - Country:US
Mailing Address - Phone:504-215-3919
Mailing Address - Fax:
Practice Address - Street 1:801 E ABRAM ST STE 208
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-1200
Practice Address - Country:US
Practice Address - Phone:504-215-3919
Practice Address - Fax:469-520-5486
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138026363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120190305001988Medicaid