Provider Demographics
NPI:1972782787
Name:HARRIS, TRACY R (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:R
Last Name:HARRIS
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 1:4056 OLD GENTILLY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-4813
Mailing Address - Country:US
Mailing Address - Phone:504-944-8889
Mailing Address - Fax:504-948-9810
Practice Address - Street 1:4056 OLD GENTILLY RD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-4813
Practice Address - Country:US
Practice Address - Phone:504-944-8889
Practice Address - Fax:504-948-9810
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05306363LF0000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101Y00000XBehavioral Health & Social Service ProvidersCounselor