Provider Demographics
NPI:1013238385
Name:TALBERT, TRACI DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:DANIEL
Last Name:TALBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:REGINA
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1805 SINGLETON AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1441
Mailing Address - Country:US
Mailing Address - Phone:512-695-9573
Mailing Address - Fax:
Practice Address - Street 1:2905 SAN GABRIEL ST STE 306
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3559
Practice Address - Country:US
Practice Address - Phone:512-474-2772
Practice Address - Fax:512-479-6002
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant