Provider Demographics
NPI:1801431622
Name:YOUNG, TRACIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5822 GARDENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4418
Mailing Address - Country:US
Mailing Address - Phone:210-380-5575
Mailing Address - Fax:
Practice Address - Street 1:1255 ASHBY ST STE G
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5100
Practice Address - Country:US
Practice Address - Phone:830-372-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily