Provider Demographics
NPI:1780182188
Name:FLYNN, TRACY BRITTON (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:BRITTON
Last Name:FLYNN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:BRITTON
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1401 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-877-2626
Mailing Address - Fax:516-877-5444
Practice Address - Street 1:1401 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-877-2626
Practice Address - Fax:516-877-5444
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF07170489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner