Provider Demographics
NPI:1770605586
Name:MARTIN, TRACEY LYNN (APRN, BC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 AUTUMN SAGE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1842
Mailing Address - Country:US
Mailing Address - Phone:702-755-8840
Mailing Address - Fax:
Practice Address - Street 1:650 N NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5382
Practice Address - Country:US
Practice Address - Phone:702-877-5310
Practice Address - Fax:702-256-3095
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7022363LF0000X, 363LP0808X
NV1087363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health