Provider Demographics
NPI:1568092013
Name:ALJABI, TRACY T (FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:T
Last Name:ALJABI
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 1:13 SHADOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-8176
Mailing Address - Country:US
Mailing Address - Phone:504-228-0372
Mailing Address - Fax:
Practice Address - Street 1:648 CRESTWOOD DR.
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:504-228-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211863363LC0200X, 363LF0000X
MS903794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA211863OtherSTATE LICENSE
LA056763OtherSTATE NARCOTICS LICENSE
LAMA5774030OtherDEA