Provider Demographics
NPI:1609122118
Name:MILLER, TRACY ANN (FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:MISHOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:161 RIVERSIDE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4178
Mailing Address - Country:US
Mailing Address - Phone:607-770-7074
Mailing Address - Fax:607-770-3452
Practice Address - Street 1:161 RIVERSIDE DR STE 109
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4178
Practice Address - Country:US
Practice Address - Phone:607-770-7074
Practice Address - Fax:607-770-3452
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03500314Medicaid
J400081121Medicare PIN