Provider Demographics
NPI:1932684388
Name:DAY, TRACEY MICHELLE
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:MICHELLE
Last Name:DAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WEXFORD DR APT 304
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7817
Mailing Address - Country:US
Mailing Address - Phone:757-201-1420
Mailing Address - Fax:
Practice Address - Street 1:316 WEXFORD DR APT 304
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7817
Practice Address - Country:US
Practice Address - Phone:757-201-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001232756163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse