Provider Demographics
NPI:1144456872
Name:FERRIS, TRACI ROSE (APRN/CRNA)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:ROSE
Last Name:FERRIS
Suffix:
Gender:F
Credentials:APRN/CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7365 MAIN ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1300
Mailing Address - Country:US
Mailing Address - Phone:203-384-3072
Mailing Address - Fax:203-384-4619
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-384-3072
Practice Address - Fax:203-384-4619
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT077657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse