Provider Demographics
NPI:1548004450
Name:BECK, TRACY DANIELLE (CNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:DANIELLE
Last Name:BECK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5171 PEBBLE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3634
Mailing Address - Country:US
Mailing Address - Phone:937-467-3419
Mailing Address - Fax:
Practice Address - Street 1:7200 POE AVE STE 201
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2799
Practice Address - Country:US
Practice Address - Phone:937-236-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036786363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics