Provider Demographics
NPI:1932771490
Name:SURRATT, TRACY SHERIE
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:SHERIE
Last Name:SURRATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NEW JERSEY AVE NW APT 1019
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5286
Mailing Address - Country:US
Mailing Address - Phone:202-845-1126
Mailing Address - Fax:
Practice Address - Street 1:901 NEW JERSEY AVE NW APT 1019
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5286
Practice Address - Country:US
Practice Address - Phone:202-845-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200001291374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide