Provider Demographics
NPI:1033450515
Name:HEADRICK, TRACEY L (NP-C)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:HEADRICK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:L
Other - Last Name:PICCININI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1000 RUSH DR
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9627
Mailing Address - Country:US
Mailing Address - Phone:719-530-2200
Mailing Address - Fax:719-530-2001
Practice Address - Street 1:1000 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9627
Practice Address - Country:US
Practice Address - Phone:719-530-2200
Practice Address - Fax:719-530-2001
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990724-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily