Provider Demographics
NPI:1154504736
Name:TRECARTIN REED, TRACEY ANN (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:TRECARTIN REED
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 STERLING PL
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-1335
Mailing Address - Country:US
Mailing Address - Phone:203-968-9907
Mailing Address - Fax:
Practice Address - Street 1:28 STERLING PL
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-1335
Practice Address - Country:US
Practice Address - Phone:203-968-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003610363LF0000X
NY334904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1648697OtherFEDERAL DEA