Provider Demographics
NPI:1851649859
Name:WRIGHT, TRACY LEIGH (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4342 NARANJA DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4010
Mailing Address - Country:US
Mailing Address - Phone:904-699-6381
Mailing Address - Fax:
Practice Address - Street 1:4342 NARANJA DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4010
Practice Address - Country:US
Practice Address - Phone:904-699-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9282939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily