Provider Demographics
NPI:1235736828
Name:TRACY, FELICIA NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:NICOLE
Last Name:TRACY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:NICOLE
Other - Last Name:LAMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:668 OTONO DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-3144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:668 OTONO DR
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-3144
Practice Address - Country:US
Practice Address - Phone:951-401-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV834823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty