Provider Demographics
NPI:1578600185
Name:SCOTT, TRACEY LYNN (WHNP-BC, BSN, MSN)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LYNN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:WHNP-BC, BSN, MSN
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LYNN
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC, BSN, MSN
Mailing Address - Street 1:4455 W 117TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2240
Mailing Address - Country:US
Mailing Address - Phone:626-457-5515
Mailing Address - Fax:626-457-6923
Practice Address - Street 1:4455 W 117TH ST STE 200
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2240
Practice Address - Country:US
Practice Address - Phone:626-457-5515
Practice Address - Fax:626-457-6923
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61409363L00000X
CA17002363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner