1770940892 NPI number — TRACY LYNNE KHAN FERNANDO MSN,APRN-RX,FNP-BC,A

Table of content: TRACY LYNNE KHAN FERNANDO MSN,APRN-RX,FNP-BC,A (NPI 1770940892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770940892 NPI number — TRACY LYNNE KHAN FERNANDO MSN,APRN-RX,FNP-BC,A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDO
Provider First Name:
TRACY LYNNE
Provider Middle Name:
KHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN,APRN-RX,FNP-BC,A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ATAGI
Provider Other First Name:
TRACY LYNNE
Provider Other Middle Name:
FERNANDO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN,APRN-RX,FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770940892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2239 N. SCHOOL ST.
Provider Second Line Business Mailing Address:
KOKUA KALIHI VALLEY
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-791-9410
Provider Business Mailing Address Fax Number:
808-847-6051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2239 N. SCHOOL ST.
Provider Second Line Business Practice Location Address:
KOKUA KALIHI VALLEY
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-791-9410
Provider Business Practice Location Address Fax Number:
808-847-6051
Provider Enumeration Date:
01/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN1979 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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