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Individual
TRACY BROUSSARD CARRONE
Active
Individual
TRACY BROUSSARD CARRONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
746675
TX
367500000X
Certified Registered Nurse Anesthetist
079620
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP116865
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195782101
—
TX
01
—
89147U
BLUE CROSS PROVIDER ID
—
01
—
P00698628
RAILROAD MEDICARE
TX
Enumeration date
04/09/2008
Last updated
07/21/2020
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