Provider Demographics
NPI:1215755061
Name:WINTERTON, TRACY LEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:WINTERTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CONSTITUTION DR # 515-5
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-3901
Mailing Address - Country:US
Mailing Address - Phone:435-823-0217
Mailing Address - Fax:
Practice Address - Street 1:118 CONSTITUTION DR # 515-5
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-3901
Practice Address - Country:US
Practice Address - Phone:435-823-0217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14184540-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily