Provider Demographics
NPI:1477699965
Name:SHORE, TRACY J (MSN,APN,CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:J
Last Name:SHORE
Suffix:
Gender:F
Credentials:MSN,APN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-1513
Mailing Address - Country:US
Mailing Address - Phone:609-712-8200
Mailing Address - Fax:
Practice Address - Street 1:132 FRANKLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2523
Practice Address - Country:US
Practice Address - Phone:609-896-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ000228363LP0200X
NJ26NJ00022800363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics