Provider Demographics
NPI:1578076345
Name:ERNEST, TRACI LINN
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LINN
Last Name:ERNEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:30 W MCCREIGHT AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1853
Mailing Address - Country:US
Mailing Address - Phone:937-523-9820
Mailing Address - Fax:513-523-9829
Practice Address - Street 1:30 W MCCREIGHT AVE STE 106
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1853
Practice Address - Country:US
Practice Address - Phone:937-523-9820
Practice Address - Fax:513-523-9829
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013815363L00000X
OHAPRN.CNP.022037363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner