Provider Demographics
NPI:1063959062
Name:THORNETT, TRACY ELIZABETH (DNP, APRN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:THORNETT
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 KEKUANAOA ST UNIT 6243
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-0209
Mailing Address - Country:US
Mailing Address - Phone:808-968-0877
Mailing Address - Fax:
Practice Address - Street 1:101 AUPUNI ST STE 108
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4260
Practice Address - Country:US
Practice Address - Phone:808-968-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2100363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner