Provider Demographics
NPI:1760795983
Name:WIRTH, TRACY MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:MARIE
Last Name:WIRTH
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:1035 CHARLEVOIX DR
Mailing Address - Street 2:STE 100
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2223
Mailing Address - Country:US
Mailing Address - Phone:989-224-3000
Mailing Address - Fax:989-224-1424
Practice Address - Street 1:1055 S US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2437
Practice Address - Country:US
Practice Address - Phone:989-224-3000
Practice Address - Fax:989-224-1424
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704195788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily