Provider Demographics
NPI:1750635710
Name:MCLEOD, TRACY BENNETT (NP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:BENNETT
Last Name:MCLEOD
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 1:214 SLATEWORTH DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6187
Mailing Address - Country:US
Mailing Address - Phone:919-638-2084
Mailing Address - Fax:
Practice Address - Street 1:3519 WITHERSPOON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6844
Practice Address - Country:US
Practice Address - Phone:919-401-1999
Practice Address - Fax:919-401-1998
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC226252163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse