Provider Demographics
NPI:1013092113
Name:HARACH, TRACY A (APN)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:A
Last Name:HARACH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SAVANNAH ROAD
Mailing Address - Street 2:BEEBE MEDICAL GROUP
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1169
Mailing Address - Country:US
Mailing Address - Phone:302-645-3300
Mailing Address - Fax:302-644-3560
Practice Address - Street 1:BEEBE MEDICAL CENTER MARGARET H. ROLLINS CAMPUS
Practice Address - Street 2:424 SAVANNAH ROAD
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1675
Practice Address - Country:US
Practice Address - Phone:302-645-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007990363LN0000X, 363LN0005X, 363L00000X
DELM0000148363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ36820Medicaid
MD4057457Medicaid
NJ36820Medicaid
090717SAJMedicare PIN