Provider Demographics
NPI:1700237088
Name:SMITH, TRACI (RN)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:SERRAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:322 WONDER OAK CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-3640
Mailing Address - Country:US
Mailing Address - Phone:415-615-5182
Mailing Address - Fax:415-615-5382
Practice Address - Street 1:50 BEALE ST
Practice Address - Street 2:12TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1813
Practice Address - Country:US
Practice Address - Phone:415-615-5182
Practice Address - Fax:415-615-5382
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA778412163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse