Provider Demographics
NPI:1215446901
Name:MAY, TRACY LEIGH (RN, CRNA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:MAY
Suffix:
Gender:F
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PASEO VESPERTINO
Mailing Address - Street 2:
Mailing Address - City:RSM
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3871
Mailing Address - Country:US
Mailing Address - Phone:949-307-0690
Mailing Address - Fax:
Practice Address - Street 1:1517 W BRADEN CT
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1125
Practice Address - Country:US
Practice Address - Phone:949-307-0690
Practice Address - Fax:949-307-0690
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA789979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse