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NPI Code Detail

MEDICARE: TRACEY LYNN MARTIN APRN, BC

MEDICARE: TRACEY LYNN MARTIN APRN, BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner7022TN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner1087NV
3363LP0808XPsychiatric/Mental Health Nurse Practitioner7022TN
4363LF0000XFamily Nurse Practitioner1087NV

General Provider Information

NPI Number : 1770605586
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY LYNN MARTIN APRN, BC
Provider Business Mailing Address
First Line : 1726 AUTUMN SAGE AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-1842
Country : US
Telephone Number : 702-755-8840
Fax Number :
Provider Business Practice Location Address
First Line : 650 N NELLIS BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89110-5382
Country : US
Telephone Number : 702-877-5310
Fax Number : 702-256-3095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 07/14/2021

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