Provider Demographics
NPI:1780131649
Name:MORENO-SILVA, TRACEY R (FNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:R
Last Name:MORENO-SILVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3928
Mailing Address - Country:US
Mailing Address - Phone:910-674-3030
Mailing Address - Fax:910-674-3051
Practice Address - Street 1:2116 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3928
Practice Address - Country:US
Practice Address - Phone:910-674-3030
Practice Address - Fax:910-674-3051
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173910363LF0000X
VA0001189033363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health