Provider Demographics
NPI:1225000284
Name:HUFFMAN, TRACIE (CRNA)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SAINT CECILIA RD
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9558
Mailing Address - Country:US
Mailing Address - Phone:724-423-6364
Mailing Address - Fax:
Practice Address - Street 1:208 SAINT CECILIA RD
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9558
Practice Address - Country:US
Practice Address - Phone:724-423-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN208464L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHU633001OtherBLUE SHIELD