Provider Demographics
NPI:1902232374
Name:DECASTRO, TRACEY GAYLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:GAYLE
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:GAYLE
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:74 JEREMY HILL RD
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-1605
Mailing Address - Country:US
Mailing Address - Phone:860-501-1326
Mailing Address - Fax:
Practice Address - Street 1:910 DOUGLAS PIKE
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1874
Practice Address - Country:US
Practice Address - Phone:401-427-6727
Practice Address - Fax:401-709-7181
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily