Provider Demographics
NPI:1437715281
Name:WHITMAN, TRACY (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ALPHA CT
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1603
Mailing Address - Country:US
Mailing Address - Phone:570-840-1365
Mailing Address - Fax:
Practice Address - Street 1:700 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1724
Practice Address - Country:US
Practice Address - Phone:866-519-0457
Practice Address - Fax:570-770-5263
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019789363LP0200X
PASP019920363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036780850001Medicaid
PA1036780850002Medicaid