Provider Demographics
NPI:1447609540
Name:HARRIS, TRACEY LYNN (DNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LYNN
Other - Last Name:FYKSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 S WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-7524
Mailing Address - Country:US
Mailing Address - Phone:715-403-5880
Mailing Address - Fax:833-972-1582
Practice Address - Street 1:2700 S WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-7524
Practice Address - Country:US
Practice Address - Phone:715-403-5880
Practice Address - Fax:833-972-1582
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127981-30363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF0616090OtherAANP CERT