Provider Demographics
NPI:1811645229
Name:GUTIERREZ, TRACY DIANE (FNP-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:DIANE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:DIANE
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3829 SARATOGA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5814
Mailing Address - Country:US
Mailing Address - Phone:361-906-2121
Mailing Address - Fax:
Practice Address - Street 1:3829 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5814
Practice Address - Country:US
Practice Address - Phone:361-906-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073253363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily