Provider Demographics
NPI:1447669379
Name:GIRARD, TRACIE (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:GIRARD
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17330 BEAR VALLEY RD STE A106
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7741
Mailing Address - Country:US
Mailing Address - Phone:760-245-9999
Mailing Address - Fax:760-245-8855
Practice Address - Street 1:17330 BEAR VALLEY ROAD, SUITE A106
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-245-9999
Practice Address - Fax:760-245-8855
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily