Provider Demographics
NPI:1043601529
Name:MARLOWE, TRACI (ACNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:MARLOWE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 VILLAGE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6410
Mailing Address - Country:US
Mailing Address - Phone:205-980-1744
Mailing Address - Fax:205-980-1334
Practice Address - Street 1:140 VILLAGE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6410
Practice Address - Country:US
Practice Address - Phone:205-980-1744
Practice Address - Fax:205-980-1334
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1081273163WP2201X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL13792350OtherCAQH
AL51157383OtherBLUE CROSS BLUE SHIELD OF ALABAMA