Healthcare Provider Details

I. General information

NPI: 1982094934
Provider Name (Legal Business Name): TRACY NGUYEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

5375 E ERICKSON DR STE 103
TUCSON AZ
85712-2838
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-5461
  • Fax:
Mailing address:
  • Phone: 520-319-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN164990
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7677
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: