Provider Demographics
NPI:1720300924
Name:SHOE, TRACIE L (CNP)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:L
Last Name:SHOE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:L
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450B WASHINGTON JACKSON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-7601
Mailing Address - Country:US
Mailing Address - Phone:937-456-8340
Mailing Address - Fax:937-456-8341
Practice Address - Street 1:450B WASHINGTON JACKSON RD STE 105
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7601
Practice Address - Country:US
Practice Address - Phone:937-456-8340
Practice Address - Fax:937-456-8341
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily