Provider Demographics
NPI:1609205244
Name:CAROLIN, TRACIE (SURGICAL FIRST ASSIS)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:CAROLIN
Suffix:
Gender:F
Credentials:SURGICAL FIRST ASSIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 END GATE LN
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1204
Mailing Address - Country:US
Mailing Address - Phone:207-615-6600
Mailing Address - Fax:
Practice Address - Street 1:8000 IH 10 W
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3802
Practice Address - Country:US
Practice Address - Phone:210-366-8032
Practice Address - Fax:830-422-6063
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant