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General NPI Number Information
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NPI Number | 1053369827
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Entity Type | Individual
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Provider Name | TRACY J WAKEFIELD MD
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 2875 S NELLIS BLVD STE 3
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City | LAS VEGAS
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State | NV
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Zip | 89121-2087
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Country | US
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Telephone | 702-843-2420
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Fax | 833-749-0351
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone | 702-843-2420
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Fax | 833-749-0351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 8072
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License Number State | NV
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