Provider Demographics
NPI:1801211461
Name:TENNITY, TRACEY MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:MARIE
Last Name:TENNITY
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 1:3896 DEWEY AVE
Mailing Address - Street 2:#156
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-2527
Mailing Address - Country:US
Mailing Address - Phone:585-455-6096
Mailing Address - Fax:
Practice Address - Street 1:3896 DEWEY AVE
Practice Address - Street 2:#156
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-2527
Practice Address - Country:US
Practice Address - Phone:585-455-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY526256163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health