Provider Demographics
NPI:1316929789
Name:HINES, TRACY A (FNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:HINES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2898
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-2898
Mailing Address - Country:US
Mailing Address - Phone:325-677-2201
Mailing Address - Fax:325-677-7641
Practice Address - Street 1:401 CYPRESS ST
Practice Address - Street 2:# 110
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5122
Practice Address - Country:US
Practice Address - Phone:325-677-2201
Practice Address - Fax:325-677-7641
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP60240Medicare UPIN
TXP00222683Medicare PIN
TX8B7656Medicare PIN