Provider Demographics
NPI:1295755965
Name:FORREST, TRACI (CNS APRN)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:FORREST
Suffix:
Gender:
Credentials:CNS APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 WONDER WORLD DR STE 4301
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7695
Mailing Address - Country:US
Mailing Address - Phone:512-353-6400
Mailing Address - Fax:512-353-3039
Practice Address - Street 1:1340 WONDER WORLD DR STE 4301
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7695
Practice Address - Country:US
Practice Address - Phone:512-353-6400
Practice Address - Fax:512-353-3039
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112909364SA2200X, 364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q00015636OtherRR MEDICARE
1L1345OtherMEDICARE
TX171196203Medicaid