Provider Demographics
NPI:1881818854
Name:BROWN, TRACY LYNN (ACNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 E TRINITY MILLS RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1942
Mailing Address - Country:US
Mailing Address - Phone:469-568-0400
Mailing Address - Fax:469-568-0405
Practice Address - Street 1:4325 N JOSEY LN
Practice Address - Street 2:PLAZA 2 SUITE 301
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4635
Practice Address - Country:US
Practice Address - Phone:469-568-0400
Practice Address - Fax:469-568-0405
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571212363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP86459Medicare UPIN
TX8A5732Medicare ID - Type Unspecified
TX8A5733Medicare ID - Type Unspecified
TX8A5734Medicare ID - Type Unspecified