Provider Demographics
NPI:1689068611
Name:YAGER, TRACY FRANCIS (NP)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:FRANCIS
Last Name:YAGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:YAGER-JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 MARYLAND AVENUE
Mailing Address - Street 2:APARTMENT 421
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:804-874-0650
Mailing Address - Fax:804-622-0552
Practice Address - Street 1:38 MARYLAND AVENUE
Practice Address - Street 2:APARTMENT 421
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:804-874-0650
Practice Address - Fax:804-622-0552
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172423363LF0000X
VA00.01208013363LF0000X
DCRN1051472363LF0000X
MDAC002632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily