Provider Demographics
NPI:1174783997
Name:AUSTIN, TRACY ESTELLE
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ESTELLE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21739 HARDY OAK BLVD
Mailing Address - Street 2:APT 6004
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2378
Mailing Address - Country:US
Mailing Address - Phone:352-279-1433
Mailing Address - Fax:
Practice Address - Street 1:2200 BERQUIST DRIVE
Practice Address - Street 2:WHMC/GE LACKLAND AFB SUITE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program