Provider Demographics
NPI:1417287004
Name:CLIFTON, TRACY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 OAK ST
Mailing Address - Street 2:APT#D
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5592
Mailing Address - Country:US
Mailing Address - Phone:303-895-7413
Mailing Address - Fax:
Practice Address - Street 1:1733 VINE STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206
Practice Address - Country:US
Practice Address - Phone:303-504-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40313164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse