Provider Demographics
NPI:1013204486
Name:MCINTYRE, TRACY ELIZABETH (APN)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ELIZABETH
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:444 NEPTUNE BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:723-775-5300
Mailing Address - Fax:732-775-1737
Practice Address - Street 1:444 NEPTUNE BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:723-775-5300
Practice Address - Fax:732-775-1737
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00333400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health