Provider Demographics
NPI:1508327560
Name:YAZVAC, TRACEY ALEXANDER (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:ALEXANDER
Last Name:YAZVAC
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OSPREY RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1829
Mailing Address - Country:US
Mailing Address - Phone:843-802-5344
Mailing Address - Fax:
Practice Address - Street 1:8 OSPREY RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1829
Practice Address - Country:US
Practice Address - Phone:843-802-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-30
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC221506163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health