Provider Demographics
NPI:1154654374
Name:GRISSETT, TRACY CHRISTIAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:CHRISTIAN
Last Name:GRISSETT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 RICE MINE RD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2300
Mailing Address - Country:US
Mailing Address - Phone:205-349-4200
Mailing Address - Fax:205-349-4285
Practice Address - Street 1:100 RICE MINE RD N
Practice Address - Street 2:SUITE B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2300
Practice Address - Country:US
Practice Address - Phone:205-349-4200
Practice Address - Fax:205-349-4285
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-093241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily