Provider Demographics
NPI:1790414266
Name:BRACY, TINA DENNELL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:DENNELL
Last Name:BRACY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:3821 TIMBER VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1839
Mailing Address - Country:US
Mailing Address - Phone:443-900-6897
Mailing Address - Fax:
Practice Address - Street 1:3821 TIMBER VIEW WAY
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1839
Practice Address - Country:US
Practice Address - Phone:410-654-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187132363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care