Provider Demographics
NPI:1780728907
Name:BITZ, TRACY (RN, NP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BITZ
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SW 3RD AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2828
Mailing Address - Country:US
Mailing Address - Phone:503-988-3976
Mailing Address - Fax:
Practice Address - Street 1:1120 SW 3RD AVE FL 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2828
Practice Address - Country:US
Practice Address - Phone:503-988-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 390200000X
CA20142363LP0808X
OR201401371NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program