Provider Demographics
NPI:1114095734
Name:GUNTER, TRACY LEIGH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LEIGH
Last Name:GUNTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:LEIGH
Other - Middle Name:GUNTER
Other - Last Name:GODFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1100 RUBY TYLER PKWY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2959
Mailing Address - Country:US
Mailing Address - Phone:205-759-2582
Mailing Address - Fax:205-759-2985
Practice Address - Street 1:1100 RUBY TYLER PKWY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2959
Practice Address - Country:US
Practice Address - Phone:205-759-2582
Practice Address - Fax:205-759-2985
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-056026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051517381Medicare PIN
ALP45718Medicare UPIN