Provider Demographics
NPI:1710301148
Name:PEER, TRACIE ANN (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:ANN
Last Name:PEER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MISS
Other - First Name:TRACIE
Other - Middle Name:ANN
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:SUITE OPF 4TH FLOOR
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-874-3919
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:SUITE OPF 4TH FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-874-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704220798363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner