Provider Demographics
NPI:1043982697
Name:TINNON, TRACEY LYNN (RN,MSN,FNP-BC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:TINNON
Suffix:
Gender:F
Credentials:RN,MSN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S OCOTILLO AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-6490
Mailing Address - Country:US
Mailing Address - Phone:520-586-2261
Mailing Address - Fax:520-586-7283
Practice Address - Street 1:688 W 4TH ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6314
Practice Address - Country:US
Practice Address - Phone:520-720-6551
Practice Address - Fax:520-720-6552
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ263513363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner