Provider Demographics
NPI:1487322038
Name:TRACONIS, SANDRA NOEMI (FNP-C)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:NOEMI
Last Name:TRACONIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:NOEMI
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9425 LOW TIDE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-0279
Mailing Address - Country:US
Mailing Address - Phone:702-245-5143
Mailing Address - Fax:
Practice Address - Street 1:216 N LAMB BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-4674
Practice Address - Country:US
Practice Address - Phone:702-459-2401
Practice Address - Fax:702-459-2405
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV845490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily