Provider Demographics
NPI:1942218573
Name:BALTZELL, TRACY HENDRICKSON (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:HENDRICKSON
Last Name:BALTZELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 KINCEY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6541
Mailing Address - Country:US
Mailing Address - Phone:877-876-3783
Mailing Address - Fax:
Practice Address - Street 1:9930 KINCEY AVE STE 100
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6541
Practice Address - Country:US
Practice Address - Phone:877-876-3783
Practice Address - Fax:855-420-6402
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001264207X00000X, 363LF0000X
NC5001264363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592711Medicare PIN