Provider Demographics
NPI:1437765872
Name:LAVINSKY, TRACIE DIANE
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:DIANE
Last Name:LAVINSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13025 ALLA DR
Mailing Address - Street 2:
Mailing Address - City:COKER
Mailing Address - State:AL
Mailing Address - Zip Code:35452-3780
Mailing Address - Country:US
Mailing Address - Phone:205-393-1054
Mailing Address - Fax:
Practice Address - Street 1:13025 ALLA DR
Practice Address - Street 2:
Practice Address - City:COKER
Practice Address - State:AL
Practice Address - Zip Code:35452-3780
Practice Address - Country:US
Practice Address - Phone:205-393-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127652363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care