Provider Demographics
NPI:1831296094
Name:MURRAY, TRACY ANN (CNP)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:15 BECKLEY FARM WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-7508
Mailing Address - Country:US
Mailing Address - Phone:937-689-5173
Mailing Address - Fax:
Practice Address - Street 1:530 LYTTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1541
Practice Address - Country:US
Practice Address - Phone:415-663-5584
Practice Address - Fax:844-640-3975
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-06-03
Deactivation Date:2019-02-07
Deactivation Code:
Reactivation Date:2019-02-19
Provider Licenses
StateLicense IDTaxonomies
OH05352363LF0000X
OHRN-283011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338867Medicaid
OHMT1471147OtherDEA
OHNP11809Medicare PIN
OHMT1471147OtherDEA
OHNP11807Medicare PIN
OHNP11808Medicare PIN