Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 263513 | AZ |
NPI | 1043982697 |
---|---|
Provider Name | Tracey Lynn Tinnon |
First Address | Sierra Vista, AZ 85635-5685 |
Second Address | Sierra Vista, AZ 85635-5685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2021 |
Last Update Date | 01/10/2021 |