Healthcare Provider Details

I. General information

NPI: 1326862483
Provider Name (Legal Business Name): TRACY TAYLOR GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ENCLAVE WAY
HUTTO TX
78634-5334
US

IV. Provider business mailing address

1110 ENCLAVE WAY
HUTTO TX
78634-5334
US

V. Phone/Fax

Practice location:
  • Phone: 512-587-7204
  • Fax:
Mailing address:
  • Phone: 512-464-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: