Provider Demographics
NPI:1538537097
Name:CHANCE, TRACY ANN
Entity type:Individual
Prefix:
First Name:TRACY ANN
Middle Name:
Last Name:CHANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1682
Mailing Address - Country:US
Mailing Address - Phone:513-376-0005
Mailing Address - Fax:513-834-9323
Practice Address - Street 1:4747 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1682
Practice Address - Country:US
Practice Address - Phone:513-376-0005
Practice Address - Fax:513-834-9323
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163WHO200X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health