Provider Demographics
NPI:1164119483
Name:FRYE, TRACY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N GREEN VALLEY PKWY # 440-127
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6170
Mailing Address - Country:US
Mailing Address - Phone:702-659-5604
Mailing Address - Fax:
Practice Address - Street 1:6767 W TROPICANA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4755
Practice Address - Country:US
Practice Address - Phone:702-209-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV846509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily