Provider Demographics
NPI:1023195005
Name:SIMONSEN, TRACY (NP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:SIMONSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 BRAE BURN DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3661
Mailing Address - Country:US
Mailing Address - Phone:661-871-1380
Mailing Address - Fax:
Practice Address - Street 1:8327 BRIMHALL RD
Practice Address - Street 2:STE 704
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2250
Practice Address - Country:US
Practice Address - Phone:661-829-7677
Practice Address - Fax:661-679-6920
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN495593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP9204OtherFURNISHING
CARN495593OtherRN
CAMS0606321OtherDEA