Provider Demographics
NPI:1770940892
Name:FERNANDO, TRACY LYNNE KHAN (MSN,APRN-RX,FNP-BC,A)
Entity type:Individual
Prefix:
First Name:TRACY LYNNE
Middle Name:KHAN
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:MSN,APRN-RX,FNP-BC,A
Other - Prefix:
Other - First Name:TRACY LYNNE
Other - Middle Name:FERNANDO
Other - Last Name:ATAGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,APRN-RX,FNP-BC
Mailing Address - Street 1:2239 N. SCHOOL ST.
Mailing Address - Street 2:KOKUA KALIHI VALLEY
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-791-9410
Mailing Address - Fax:808-847-6051
Practice Address - Street 1:2239 N. SCHOOL ST.
Practice Address - Street 2:KOKUA KALIHI VALLEY
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-791-9410
Practice Address - Fax:808-847-6051
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN1979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily