Provider Demographics
NPI:1033547716
Name:HARTSOCK, TRACY (RN)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:HARTSOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 SUNNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24435-2312
Mailing Address - Country:US
Mailing Address - Phone:443-717-2563
Mailing Address - Fax:
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 1204
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-585-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001229495163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse