Provider Demographics
NPI:1871956706
Name:TRACEY COOK
Entity type:Organization
Organization Name:TRACEY COOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:949-300-3983
Mailing Address - Street 1:1851 PAROS CIR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4709
Mailing Address - Country:US
Mailing Address - Phone:949-300-3983
Mailing Address - Fax:
Practice Address - Street 1:1851 PAROS CIR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4709
Practice Address - Country:US
Practice Address - Phone:949-300-3983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA661472251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care