Provider Demographics
NPI:1699555920
Name:SMITH, TRICIA JEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:TRICIA
Other - Middle Name:JEAN
Other - Last Name:VAN CLEAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:1628 CRABB RIVER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5890
Practice Address - Country:US
Practice Address - Phone:281-545-8090
Practice Address - Fax:281-545-8339
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily