Provider Demographics
NPI:1063162550
Name:HOUSTON, TRACEY NICOLE (CSFA)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:NICOLE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E PRATER WAY APT H
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4632
Mailing Address - Country:US
Mailing Address - Phone:512-318-8200
Mailing Address - Fax:
Practice Address - Street 1:625 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2215
Practice Address - Country:US
Practice Address - Phone:775-799-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant