Provider Demographics
NPI:1962892950
Name:EATON, TRACEY M (FNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:EATON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 BROOKWOOD AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4513
Mailing Address - Country:US
Mailing Address - Phone:707-303-8349
Mailing Address - Fax:707-303-8694
Practice Address - Street 1:85 BROOKWOOD AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4513
Practice Address - Country:US
Practice Address - Phone:707-303-8349
Practice Address - Fax:707-303-8694
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANPF95001608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily