Provider Demographics
NPI:1033516810
Name:SOLAZZO, TRACY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:SOLAZZO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 OCONNOR RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5850
Mailing Address - Country:US
Mailing Address - Phone:315-679-3825
Mailing Address - Fax:
Practice Address - Street 1:83 OCONNOR RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-5850
Practice Address - Country:US
Practice Address - Phone:315-679-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-23
Last Update Date:2014-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-503378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse