Provider Demographics
NPI:1548041916
Name:GRAY, TRACY RENEE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:RENEE
Last Name:GRAY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16608 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-7620
Mailing Address - Country:US
Mailing Address - Phone:928-581-6060
Mailing Address - Fax:
Practice Address - Street 1:7150 E 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-1179
Practice Address - Country:US
Practice Address - Phone:928-502-6427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ124025163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool