Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 211863 | LA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 211863 | LA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 903794 | MS |
NPI | 1568092013 |
---|---|
Provider Name | Tracy T Aljabi |
First Address | Carriere, MS 39426-8176 |
Second Address | Covington, LA 70433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2020 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056763 | STATE NARCOTICS LICENSE (01) | LA |
211863 | STATE LICENSE (01) | LA |
MA5774030 | DEA (01) | LA |