Provider Demographics
NPI:1083340210
Name:FLEISCHMAN, TRACY S (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:S
Last Name:FLEISCHMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1501
Mailing Address - Country:US
Mailing Address - Phone:716-930-0325
Mailing Address - Fax:
Practice Address - Street 1:3376 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1396
Practice Address - Country:US
Practice Address - Phone:716-264-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309511133NN1002X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner