Provider Demographics
NPI:1992971154
Name:SOWADA, TRACY L (RN, MSN, CNS)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:SOWADA
Suffix:
Gender:F
Credentials:RN, MSN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E HIGHWAY 290 STE 420
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1098
Mailing Address - Country:US
Mailing Address - Phone:125-486-9569
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:10401 ANDERSON MILL RD STE 110B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750
Practice Address - Country:US
Practice Address - Phone:512-250-5571
Practice Address - Fax:512-406-7300
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681739364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196973505Medicaid
TX196973506Medicaid
TX196973504Medicaid
TX196973501Medicaid
TX196973507Medicaid
TX196973502Medicaid
TX196973504Medicaid
TX196973505Medicaid