Provider Demographics
NPI:1235297987
Name:O'NEIL, TRACY ROBERTS (DNP, C-PNP)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ROBERTS
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:DNP, C-PNP
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:ROBERTS
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, CPNP
Mailing Address - Street 1:PO BOX 3000
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-3000
Mailing Address - Country:US
Mailing Address - Phone:910-715-2164
Mailing Address - Fax:910-715-1247
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-715-2164
Practice Address - Fax:910-715-1247
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74607363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1235297987Medicare UPIN