Provider Demographics
NPI:1194415026
Name:BARAJAS, GRACIELA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:GRACIELA
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 TWIN LN
Mailing Address - Street 2:
Mailing Address - City:WESTWORTH VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4247
Mailing Address - Country:US
Mailing Address - Phone:817-880-5145
Mailing Address - Fax:
Practice Address - Street 1:12300 BEAR PLZ STE 408
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-9501
Practice Address - Country:US
Practice Address - Phone:817-585-1768
Practice Address - Fax:817-585-1373
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1109772207QA0505X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty