Provider Demographics
NPI:1003142662
Name:NASH, TRACEY A I (R N)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:A
Last Name:NASH
Suffix:I
Gender:F
Credentials:R N
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:A
Other - Last Name:NASH
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 3323
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-3323
Mailing Address - Country:US
Mailing Address - Phone:914-439-4474
Mailing Address - Fax:
Practice Address - Street 1:178 FLAX HILL RD APT B204
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2877
Practice Address - Country:US
Practice Address - Phone:914-439-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY486559-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No104100000XBehavioral Health & Social Service ProvidersSocial Worker