Provider Demographics
NPI:1275973729
Name:RICKARD, TRACY B (NP)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:B
Last Name:RICKARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 PROSPERITY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4330
Mailing Address - Country:US
Mailing Address - Phone:703-289-1400
Mailing Address - Fax:703-289-1414
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-6020
Practice Address - Fax:703-776-6058
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024115505363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal