Provider Demographics
NPI:1396961876
Name:POEPPING, TRACY SHEA (NP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:SHEA
Last Name:POEPPING
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 1:30343 INVERNESS LN
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439
Mailing Address - Country:US
Mailing Address - Phone:303-670-0148
Mailing Address - Fax:
Practice Address - Street 1:10099 RIDGE GATE PKWY
Practice Address - Street 2:#290
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-791-2112
Practice Address - Fax:303-683-6415
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC071400363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORXN9939OtherPRESCRIPTION ID #
CO71400OtherSTATE ID #