Provider Demographics
NPI:1093727737
Name:GOSS, TRACIE (NP)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:GOSS
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 1:147 REYNOIR ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-4109
Mailing Address - Country:US
Mailing Address - Phone:228-436-1181
Mailing Address - Fax:
Practice Address - Street 1:147 REYNOIR ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4109
Practice Address - Country:US
Practice Address - Phone:228-436-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR809052363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner