Provider Demographics
NPI:1952968976
Name:PERRY, TRACEY (FNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:PERRY
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 1:103 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:OH
Mailing Address - Zip Code:44807-9472
Mailing Address - Country:US
Mailing Address - Phone:419-618-4763
Mailing Address - Fax:
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:OH
Practice Address - Zip Code:44807-9472
Practice Address - Country:US
Practice Address - Phone:419-618-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF04190580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily