Provider Demographics
NPI:1407488455
Name:TRACY, ANDREW MARCELLOUS (MSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARCELLOUS
Last Name:TRACY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N GREEN VALLEY PKWY STE 118
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2158
Mailing Address - Country:US
Mailing Address - Phone:702-476-8809
Mailing Address - Fax:
Practice Address - Street 1:2501 N GREEN VALLEY PKWY STE 118
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2158
Practice Address - Country:US
Practice Address - Phone:702-476-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7854PCS3374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide