Provider Demographics
NPI:1518204700
Name:SEABERRY, TRACY TIJUANA (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:TIJUANA
Last Name:SEABERRY
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 1:4501 BROOKS ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105
Mailing Address - Country:US
Mailing Address - Phone:216-797-1718
Mailing Address - Fax:
Practice Address - Street 1:4501 BROOKS RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6054
Practice Address - Country:US
Practice Address - Phone:216-797-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH255990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse