Provider Demographics
NPI:1780638510
Name:GANLEY, TRACEY M (APN-C)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:M
Last Name:GANLEY
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DAVIS AVE
Mailing Address - Street 2:2ND FLR-HEM/ONC
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-528-0760
Mailing Address - Fax:732-528-0754
Practice Address - Street 1:1707 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1147
Practice Address - Country:US
Practice Address - Phone:732-528-0760
Practice Address - Fax:732-528-4695
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00076900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health