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NPI Code Detail

MEDICARE: TRACY LYNN WEAVER CNP

MEDICARE: TRACY LYNN WEAVER CNP
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
1207Q00000XFamily Medicine Physician1012889TX

General Provider Information

NPI Number : 1417563941
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY LYNN WEAVER CNP
Provider Business Mailing Address
First Line : 6417 STONE CREEK TER
Second Line :
City : FT WORTH
State : TX
Zip : 76137-1926
Country : US
Telephone Number : 513-827-0376
Fax Number :
Provider Business Practice Location Address
First Line : 3101 N TARRANT PKWY
Second Line :
City : FT WORTH
State : TX
Zip : 76177-8601
Country : US
Telephone Number : 817-639-1360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2020
Last Update Date : 09/21/2020

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Directions to “ TRACY LYNN WEAVER CNP” Practice Location

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