Provider Demographics
NPI:1609142504
Name:TRACY, BARBARA S (MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:S
Last Name:TRACY
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MANDALAY RD
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-9455
Mailing Address - Country:US
Mailing Address - Phone:413-243-1122
Mailing Address - Fax:
Practice Address - Street 1:21 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-1633
Practice Address - Country:US
Practice Address - Phone:413-243-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN178475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily