Provider Demographics
NPI:1083987648
Name:SHULSINGER, TRACY LEIGH (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:SHULSINGER
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:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:720-572-5326
Mailing Address - Fax:720-684-6913
Practice Address - Street 1:6800 N 79TH ST STE 202
Practice Address - Street 2:
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80503
Practice Address - Country:US
Practice Address - Phone:720-572-5326
Practice Address - Fax:720-684-6913
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO177886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner