Provider Demographics
NPI:1689225534
Name:GRAHAM, TRACEY LYNN (DNP, FNP-C ARNP)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:LYNN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DNP, FNP-C ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HEATH CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-7044
Mailing Address - Country:US
Mailing Address - Phone:850-418-0945
Mailing Address - Fax:
Practice Address - Street 1:202 HEATH CT
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602
Practice Address - Country:US
Practice Address - Phone:850-418-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170483363LF0000X
FL9174553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily