Provider Demographics
NPI:1932574662
Name:BRENNAN, TRACI LYNNE (CRNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNNE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LYNNE
Other - Last Name:KALUSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:420 W LINFIELD TRAPPE RD
Mailing Address - Street 2:BLDG. A, SUITE 1000
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-4278
Mailing Address - Country:US
Mailing Address - Phone:610-495-2656
Mailing Address - Fax:
Practice Address - Street 1:420 W LINFIELD TRAPPE RD
Practice Address - Street 2:BLDG. A, SUITE 1000
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-4278
Practice Address - Country:US
Practice Address - Phone:610-495-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily