Provider Demographics
NPI:1790357564
Name:ADAMS, TRACIE (FNP-C)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7089 RED BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-4972
Mailing Address - Country:US
Mailing Address - Phone:615-388-4242
Mailing Address - Fax:
Practice Address - Street 1:7089 RED BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-4972
Practice Address - Country:US
Practice Address - Phone:615-388-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29988363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care