Provider Demographics
NPI:1609373034
Name:AVIGNONE, TRACY ELIZABETH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ELIZABETH
Last Name:AVIGNONE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:ELIZABETH
Other - Last Name:NOTARIO, DUARTE, HILEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2051 MARENGO ST # C5L100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1352
Mailing Address - Country:US
Mailing Address - Phone:323-409-8604
Mailing Address - Fax:323-441-9907
Practice Address - Street 1:2051 MARENGO ST # C5L100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1352
Practice Address - Country:US
Practice Address - Phone:323-409-8604
Practice Address - Fax:323-441-9907
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily