Provider Demographics
NPI:1235174186
Name:NOELL, TRACY A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:A
Last Name:NOELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 MARSHALL PHELPS ROAD
Mailing Address - Street 2:HEALTHONE WINDSOR FAMILY MEDICINE
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095
Mailing Address - Country:US
Mailing Address - Phone:860-683-0756
Mailing Address - Fax:860-683-1555
Practice Address - Street 1:851 MARSHALL PHELPS ROAD
Practice Address - Street 2:HEALTHONE WINDSOR FAMILY MEDICINE
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095
Practice Address - Country:US
Practice Address - Phone:860-683-0756
Practice Address - Fax:860-683-1555
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004256344Medicaid
CT500001632OtherRAILROAD MEDICARE
CTQ61919Medicare UPIN
CT004256344Medicaid