Provider Demographics
NPI:1003493958
Name:OMOROGIEVA, TRACY O (APN-CNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:O
Last Name:OMOROGIEVA
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE # 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-3175
Mailing Address - Fax:847-982-3394
Practice Address - Street 1:3060 W SALT CREEK LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1069
Practice Address - Country:US
Practice Address - Phone:847-242-6700
Practice Address - Fax:847-618-6770
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily