Provider Demographics
NPI:1558069690
Name:CORTEZAVAD, TRACY (APRN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CORTEZAVAD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3593 MEDINA RD STE 181
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8182
Mailing Address - Country:US
Mailing Address - Phone:330-536-3746
Mailing Address - Fax:419-696-8819
Practice Address - Street 1:3567 RESERVE COMMONS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-536-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.368860163W00000X
OHAPRN.CNP.0033297363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse