Provider Demographics
NPI:1710592761
Name:RICH, TRACI S (FNP-C)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:S
Last Name:RICH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 BURKE CENTRE PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2234
Mailing Address - Country:US
Mailing Address - Phone:571-484-0322
Mailing Address - Fax:703-454-0299
Practice Address - Street 1:5631 BURKE CENTRE PKWY STE C
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2234
Practice Address - Country:US
Practice Address - Phone:571-454-5771
Practice Address - Fax:703-454-0299
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily