Provider Demographics
NPI:1831978444
Name:THOMPSON, TRACEY LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6418 COLLEGE GROVE DR UNIT 12
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5297
Mailing Address - Country:US
Mailing Address - Phone:619-218-2164
Mailing Address - Fax:
Practice Address - Street 1:6418 COLLEGE GROVE DRIVE
Practice Address - Street 2:UNIT 12
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5297
Practice Address - Country:US
Practice Address - Phone:619-218-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623560163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse