MEDICARE: TRALYNN VICTORIAN

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	AP125837	TX
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	AP125837	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366856023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRALYNN VICTORIAN

Provider Business Mailing Address
First Line	:	5615 NW CENTRAL DR STE C105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-2048
Country	:	US
Telephone Number	:	832-791-3295
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 NW CENTRAL DR STE C105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-2048
Country	:	US
Telephone Number	:	832-791-3295
Fax Number	:	346-410-0067

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

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	08/06/2025

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Directions to “ TRALYNN VICTORIAN ” Practice Location

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