Provider Demographics
NPI:1043563463
Name:ROEHL, TRACY ANN (APRN CNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANN
Last Name:ROEHL
Suffix:
Gender:F
Credentials:APRN CNP
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Mailing Address - Street 1:1900 CENTRACARE CIR # 2300
Mailing Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA OBSTETRICS AND WOMEN'S H
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR # 2300
Practice Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA OBSTETRICS AND WOMEN'S H
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2015-03-03
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Provider Licenses
StateLicense IDTaxonomies
MNR184825-8163WM0705X
MNF1012160363LF0000X
MNCNP0403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical