Provider Demographics
NPI:1720722366
Name:TRACY, ANNALIE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ANNALIE
Middle Name:
Last Name:TRACY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 N WESTRIDGE DR UNIT 131
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-8034
Mailing Address - Country:US
Mailing Address - Phone:505-977-1150
Mailing Address - Fax:
Practice Address - Street 1:187 N WESTRIDGE DR UNIT 131
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-8034
Practice Address - Country:US
Practice Address - Phone:505-977-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108366674405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily