Provider Demographics
NPI:1164721866
Name:FUTCH-WEST, TRACI LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:FUTCH-WEST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FORTENBERRY RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3616
Mailing Address - Country:US
Mailing Address - Phone:321-453-0779
Mailing Address - Fax:321-453-4188
Practice Address - Street 1:40 FORTENBERRY RD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3616
Practice Address - Country:US
Practice Address - Phone:321-453-0779
Practice Address - Fax:321-453-4188
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9193030363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics