Provider Demographics
NPI:1578552691
Name:WOEHL, TRACY CORDELL (CRNA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:CORDELL
Last Name:WOEHL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260995
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-0995
Mailing Address - Country:US
Mailing Address - Phone:214-686-1558
Mailing Address - Fax:972-226-2911
Practice Address - Street 1:3801 W 15TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4737
Practice Address - Country:US
Practice Address - Phone:972-543-2477
Practice Address - Fax:972-543-2499
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644539367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1097180-03Medicaid
TX1097180-03Medicaid
81919HMedicare ID - Type Unspecified