Provider Demographics
NPI:1598018111
Name:JONES, TRACY FRANCINE (RN)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:FRANCINE
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-2703
Mailing Address - Country:US
Mailing Address - Phone:505-287-5601
Mailing Address - Fax:505-287-9343
Practice Address - Street 1:617 N 1ST ST
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2703
Practice Address - Country:US
Practice Address - Phone:505-287-5601
Practice Address - Fax:505-287-9343
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMIT3407251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM616608700OtherDEEOICP