Provider Demographics
NPI:1144711938
Name:SMITH, TRACEY SIMONE (FNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:SIMONE
Last Name:SMITH
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 1:228 LOGAN ST FL 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1965
Mailing Address - Country:US
Mailing Address - Phone:347-479-7266
Mailing Address - Fax:
Practice Address - Street 1:228 LOGAN ST FL 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1965
Practice Address - Country:US
Practice Address - Phone:347-479-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY661055-1163WH1000X
NYF-343235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH1000XNursing Service ProvidersRegistered NurseHospice