Provider Demographics
NPI:1750599098
Name:ROBERSON, TRACEY (MS, RN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MS, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 CAMP BOWIE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-6313
Mailing Address - Country:US
Mailing Address - Phone:817-244-4620
Mailing Address - Fax:817-560-7159
Practice Address - Street 1:8030 CAMP BOWIE W
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6313
Practice Address - Country:US
Practice Address - Phone:817-244-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily