Healthcare Provider Details

I. General information

NPI: 1376369967
Provider Name (Legal Business Name): TRACIE ANN TJAPKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 LUNAAI ST
KAILUA HI
96734-4635
US

IV. Provider business mailing address

1082 LUNAAI ST
KAILUA HI
96734-4635
US

V. Phone/Fax

Practice location:
  • Phone: 808-492-2087
  • Fax:
Mailing address:
  • Phone: 808-492-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number444958303
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: