Provider Demographics
NPI:1679086433
Name:DAZET, TRACY ANNE (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANNE
Last Name:DAZET
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 1:6128 PELICAN CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8616
Mailing Address - Country:US
Mailing Address - Phone:901-351-6701
Mailing Address - Fax:
Practice Address - Street 1:6128 PELICAN CROSSING DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8616
Practice Address - Country:US
Practice Address - Phone:901-351-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN134163163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine