Provider Demographics
NPI:1245663665
Name:EDWARDS, TRACY LEA (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LEA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1347 OLD CHARLOTTE PIKE
Mailing Address - Street 2:
Mailing Address - City:PEGRAM
Mailing Address - State:TN
Mailing Address - Zip Code:37143-5013
Mailing Address - Country:US
Mailing Address - Phone:615-519-8644
Mailing Address - Fax:
Practice Address - Street 1:211 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7242
Practice Address - Country:US
Practice Address - Phone:615-778-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17870363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner