Provider Demographics
NPI:1134171887
Name:JONES, TRACEY E (CRNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:E
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29653 ANCHOR CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9594
Mailing Address - Country:US
Mailing Address - Phone:251-625-6896
Mailing Address - Fax:251-625-6897
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:BLDG B T-LEVEL
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-625-6896
Practice Address - Fax:251-625-6897
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1075963207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891017040Medicaid
AL891017040Medicaid