Provider Demographics
NPI:1043204969
Name:CARSTARPHEN, TRACY ANDREA (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANDREA
Last Name:CARSTARPHEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANDREA
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2651 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-1325
Mailing Address - Country:US
Mailing Address - Phone:615-673-6737
Mailing Address - Fax:800-474-4039
Practice Address - Street 1:5470 MERIDIAN MARKS RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:615-673-6737
Practice Address - Fax:800-474-4039
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201683363LP0808X, 363LP2300X
GA165081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
2631996OtherUNITED HEALTHCARE
NC6005024Medicaid
NC2809124Medicare PIN
2631996OtherUNITED HEALTHCARE
NC6005024Medicaid