Provider Demographics
NPI:1487015459
Name:PRINCE, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:PRINCE
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 1:12526 TAMBOURINE DR
Mailing Address - Street 2:C
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1275
Mailing Address - Country:US
Mailing Address - Phone:713-474-6485
Mailing Address - Fax:
Practice Address - Street 1:12526 TAMBOURINE DR
Practice Address - Street 2:C
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-1275
Practice Address - Country:US
Practice Address - Phone:713-474-6485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health