Provider Demographics
NPI:1679901409
Name:ECKENROD, TRACEY ANN (MSN CRNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:ECKENROD
Suffix:
Gender:F
Credentials:MSN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SCHOOLHOUSE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3239
Mailing Address - Country:US
Mailing Address - Phone:814-266-5650
Mailing Address - Fax:814-266-5653
Practice Address - Street 1:136 JAYCEE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3650
Practice Address - Country:US
Practice Address - Phone:814-467-4055
Practice Address - Fax:814-467-3783
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily