Healthcare Provider Details

I. General information

NPI: 1336649219
Provider Name (Legal Business Name): TRACY OGAN-SANFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY SANFORD RN

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12371 S KIRKWOOD RD
STAFFORD TX
77477-2836
US

IV. Provider business mailing address

21403 CHERRY CANYON LN
TOMBALL TX
77375-0464
US

V. Phone/Fax

Practice location:
  • Phone: 713-995-9292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number922859
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: