Provider Demographics
NPI:1558092791
Name:MARIA, TRACY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:MARIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8000
Mailing Address - Country:US
Mailing Address - Phone:704-378-8478
Mailing Address - Fax:704-412-9737
Practice Address - Street 1:128 E PLAZA DR # 3&4
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-8000
Practice Address - Country:US
Practice Address - Phone:704-378-8478
Practice Address - Fax:704-412-9737
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily