Provider Demographics
NPI:1164766291
Name:LYOU, TRACY ANN (FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:LYOU
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 1:168 N BRENT ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2817
Mailing Address - Country:US
Mailing Address - Phone:805-641-2000
Mailing Address - Fax:805-641-5631
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:SUITE 502
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2817
Practice Address - Country:US
Practice Address - Phone:805-641-2000
Practice Address - Fax:805-641-5631
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP21535OtherLICENSE