Healthcare Provider Details

I. General information

NPI: 1669857157
Provider Name (Legal Business Name): TRACI SHEFCIK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 N VIRGINIA ST
PORT LAVACA TX
77979-3000
US

IV. Provider business mailing address

815 N VIRGINIA ST
PORT LAVACA TX
77979-3025
US

V. Phone/Fax

Practice location:
  • Phone: 361-552-0325
  • Fax: 361-500-6904
Mailing address:
  • Phone: 361-552-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128548
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: