Provider Demographics
NPI:1164206587
Name:PETLESKI, TRACY ANN (DNP, CNL-BC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANN
Last Name:PETLESKI
Suffix:
Gender:F
Credentials:DNP, CNL-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 QUEENS RD APT 20
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3209
Mailing Address - Country:US
Mailing Address - Phone:704-351-6062
Mailing Address - Fax:
Practice Address - Street 1:308 QUEENS RD APT 20
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3209
Practice Address - Country:US
Practice Address - Phone:704-351-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101248163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency