Individual
TRACI RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3516 22ND PL, LUBBOCK, TX 79410-1316
(806) 771-1386
(806) 771-1388
Mailing address
PO BOX 54136, LUBBOCK, TX 79453-4136
(806) 771-1386
(806) 771-1388
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
577500
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124233109
—
TX
05
—
141133203
—
TX
05
—
141133204
—
TX
01
—
8Y0236
BLUE CROSS BLUE SHIELD
TX
01
—
P00090182
RR MEDICARE
TX
01
—
P00216190
RR MEDICARE
TX
01
—
P00317552
RR MEDICARE
TX
Enumeration date
07/04/2006
Last updated
01/27/2022
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