Provider Demographics
NPI:1629514286
Name:GEORGE, TRACIE D (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:D
Last Name:GEORGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:D
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2809 DENNY AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5301
Mailing Address - Country:US
Mailing Address - Phone:228-809-5566
Mailing Address - Fax:
Practice Address - Street 1:2809 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5301
Practice Address - Country:US
Practice Address - Phone:228-809-5566
Practice Address - Fax:228-809-5414
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily