Provider Demographics
NPI:1750645545
Name:WINDHAM, TRACY ROCHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ROCHELLE
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ROCHELLE
Other - Last Name:CREAMER, STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2100 W WHITE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5155
Mailing Address - Country:US
Mailing Address - Phone:972-587-6080
Mailing Address - Fax:972-872-8667
Practice Address - Street 1:2100 W WHITE ST STE 150
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-5159
Practice Address - Country:US
Practice Address - Phone:972-587-6080
Practice Address - Fax:972-872-8667
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX599539163WG0000X
TXAP121869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice