Provider Demographics
NPI:1548346539
Name:HUTCHISON, TRACY KRISTINA ABENOJA (FNP-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:KRISTINA ABENOJA
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:KRISTINA
Other - Last Name:ABENOJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:219 MULBERRY CROSSING DRIVE
Mailing Address - Street 2:
Mailing Address - City:CATAULA
Mailing Address - State:GA
Mailing Address - Zip Code:31804
Mailing Address - Country:US
Mailing Address - Phone:206-898-0969
Mailing Address - Fax:
Practice Address - Street 1:6600 VAN AALST BLVD
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-2102
Practice Address - Country:US
Practice Address - Phone:762-408-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI55601163W00000X
HI1487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse