MEDICARE: TRACIE HARRISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	601099	TX

General Provider Information

NPI Number	:	1316137540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACIE HARRISON

Provider Business Mailing Address
First Line	:	1700 RED RIVER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1412
Country	:	US
Telephone Number	:	512-471-9085
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 RED RIVER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1412
Country	:	US
Telephone Number	:	512-471-9085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	07/25/2007

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Directions to “ TRACIE HARRISON ” Practice Location

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