Provider Demographics
NPI:1033681655
Name:SOPER, TRACEY (FNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:SOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1345
Mailing Address - Street 2:
Mailing Address - City:CARMEL BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:93921-1345
Mailing Address - Country:US
Mailing Address - Phone:904-463-5437
Mailing Address - Fax:
Practice Address - Street 1:245 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2409
Practice Address - Country:US
Practice Address - Phone:831-372-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily