Provider Demographics
NPI:1033908983
Name:OUTLAW, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:OUTLAW
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-2225
Mailing Address - Country:US
Mailing Address - Phone:240-447-7134
Mailing Address - Fax:240-447-7134
Practice Address - Street 1:1921 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-2225
Practice Address - Country:US
Practice Address - Phone:240-242-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR247038163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse