Provider Demographics
NPI:1861413445
Name:GIAMBRONE, TRACEY E (DPM)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:E
Last Name:GIAMBRONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8173
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89507-8173
Mailing Address - Country:US
Mailing Address - Phone:775-786-5333
Mailing Address - Fax:775-786-5333
Practice Address - Street 1:3400 KAUAI CT
Practice Address - Street 2:SUITE #103
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4850
Practice Address - Country:US
Practice Address - Phone:775-786-5333
Practice Address - Fax:775-786-5333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2060213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002116016Medicaid
NVV38765Medicare ID - Type UnspecifiedMEDICARE
NV002116016Medicaid
NVV38763Medicare ID - Type UnspecifiedMEDICARE GROUP