Provider Demographics
NPI:1366321549
Name:WATSON, TRACEY ELIZABETH (RN)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ELIZABETH
Last Name:WATSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:REISETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18219 N 66TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-6711
Mailing Address - Country:US
Mailing Address - Phone:480-653-1588
Mailing Address - Fax:
Practice Address - Street 1:18219 N 66TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-6711
Practice Address - Country:US
Practice Address - Phone:480-653-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251121163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice