Provider Demographics
NPI:1265406664
Name:RAY, TRACIE JOANNA (CRNA)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:JOANNA
Last Name:RAY
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:J
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:8800 N TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3300
Mailing Address - Country:US
Mailing Address - Phone:704-562-1592
Mailing Address - Fax:
Practice Address - Street 1:8800 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3300
Practice Address - Country:US
Practice Address - Phone:423-309-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN128627367500000X
TN072233367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN11195OtherADVANCED PRACTICE NURSE
3634161Medicare ID - Type Unspecified