Provider Demographics
NPI:1295724862
Name:MCCLOSKEY, TRACEY A (CRNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:A
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-0290
Mailing Address - Country:US
Mailing Address - Phone:301-290-0395
Mailing Address - Fax:301-290-0396
Practice Address - Street 1:30065 BUSINESS CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622
Practice Address - Country:US
Practice Address - Phone:301-290-0395
Practice Address - Fax:301-290-0396
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR068299163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS03071Medicare UPIN
MD985LMedicare PIN