Provider Demographics
NPI:1396741609
Name:TRACY, CAROL LYNN (NP,CNM)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:TRACY
Suffix:
Gender:F
Credentials:NP,CNM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1685 HOLLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597
Mailing Address - Country:US
Mailing Address - Phone:925-254-9000
Mailing Address - Fax:925-254-0687
Practice Address - Street 1:12 CAMINO ENCINAS
Practice Address - Street 2:#15
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563
Practice Address - Country:US
Practice Address - Phone:925-254-9000
Practice Address - Fax:925-254-0678
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANMW157367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife