Provider Demographics
NPI:1225573199
Name:BRANNOCK, TRACY M (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:BRANNOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 BANISTER RD
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2822
Mailing Address - Country:US
Mailing Address - Phone:443-453-6115
Mailing Address - Fax:844-965-9440
Practice Address - Street 1:8304 BANISTER RD
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2822
Practice Address - Country:US
Practice Address - Phone:443-453-6115
Practice Address - Fax:844-965-9440
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN145478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse