Provider Demographics
NPI:1619476819
Name:KRANGEL, TRACEY (MSN, RN-BC, AGCNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:KRANGEL
Suffix:
Gender:F
Credentials:MSN, RN-BC, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LYON CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 LYON CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2619
Practice Address - Country:US
Practice Address - Phone:973-219-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA815022163WC0200X
CA4264364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4264OtherSTATE LICENSE/CERTIFICATE NUMBER