Provider Demographics
NPI:1245599331
Name:EBERSBACH, TRACY LEIGH (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEIGH
Last Name:EBERSBACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEIGH
Other - Last Name:SEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13082 GRANT CIR E UNIT C
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3489
Mailing Address - Country:US
Mailing Address - Phone:303-905-9735
Mailing Address - Fax:
Practice Address - Street 1:8931 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6806
Practice Address - Country:US
Practice Address - Phone:303-853-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO169671163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse