Provider Demographics
NPI:1528098316
Name:SPRINGER-TRACY, CONSTANCE M (FNP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:M
Last Name:SPRINGER-TRACY
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 1:1405 MAIN RD.
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:ME
Mailing Address - Zip Code:04419-3411
Mailing Address - Country:US
Mailing Address - Phone:207-941-4078
Mailing Address - Fax:207-941-4062
Practice Address - Street 1:656 STATE STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5609
Practice Address - Country:US
Practice Address - Phone:207-941-4036
Practice Address - Fax:207-941-4062
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER028586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P38070Medicare UPIN
MENP3407Medicare ID - Type Unspecified