Provider Demographics
NPI:1306366455
Name:HILL, TRACI DIANA (APN)
Entity Type:Individual
Prefix:MISS
First Name:TRACI
Middle Name:DIANA
Last Name:HILL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LACEY ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759
Mailing Address - Country:US
Mailing Address - Phone:732-849-1075
Mailing Address - Fax:
Practice Address - Street 1:401 LACEY RD STE B
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1386
Practice Address - Country:US
Practice Address - Phone:732-849-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00708200363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology