Provider Demographics
NPI:1326634866
Name:BEACH, TRACY SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:SUE
Last Name:BEACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 HIGHLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-9258
Mailing Address - Country:US
Mailing Address - Phone:740-485-4800
Mailing Address - Fax:
Practice Address - Street 1:592 HIGHLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:OH
Practice Address - Zip Code:43028-9258
Practice Address - Country:US
Practice Address - Phone:740-485-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN450801163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health