Provider Demographics
NPI:1740046507
Name:TRACY, GENE VELITARIO (AGACNP)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:VELITARIO
Last Name:TRACY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 RANCH FLS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3172
Mailing Address - Country:US
Mailing Address - Phone:336-650-6897
Mailing Address - Fax:
Practice Address - Street 1:16620 SAN PEDRO AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2679
Practice Address - Country:US
Practice Address - Phone:210-871-4701
Practice Address - Fax:210-688-4596
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1086459363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care