Healthcare Provider Details

I. General information

NPI: 1992641633
Provider Name (Legal Business Name): TRACY LYNN CARLIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9327 LAKE MURRAY BLVD UNIT E
SAN DIEGO CA
92119-1462
US

IV. Provider business mailing address

9327 LAKE MURRAY BLVD UNIT E
SAN DIEGO CA
92119-1462
US

V. Phone/Fax

Practice location:
  • Phone: 619-838-1145
  • Fax:
Mailing address:
  • Phone: 619-838-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number637110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: