Provider Demographics
NPI:1689191306
Name:BRITTO, TRACY (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BRITTO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WILD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6584
Mailing Address - Country:US
Mailing Address - Phone:864-720-3544
Mailing Address - Fax:
Practice Address - Street 1:1330 BOILING SPRINGS RD STE 1600
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4219
Practice Address - Country:US
Practice Address - Phone:642-859-3148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6607Medicaid
SCSCG4616067OtherMEDICARE PIN