Provider Demographics
NPI:1619160116
Name:MITCHELL, TRACEY ANN C (CRNP)
Entity Type:Individual
Prefix:
First Name:TRACEY ANN
Middle Name:C
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SPRUCE ST
Mailing Address - Street 2:PINE 1 EAST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-829-7817
Mailing Address - Fax:215-829-7129
Practice Address - Street 1:800 SPRUCE ST
Practice Address - Street 2:1 PINE WEST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-7817
Practice Address - Fax:215-829-7129
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008871363LF0000X
PASP015853363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily