Provider Demographics
NPI:1710380621
Name:CHURCH, TRACI ANN (CRNP)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:ANN
Last Name:CHURCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1322 BELMONT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4593
Mailing Address - Country:US
Mailing Address - Phone:410-749-6833
Mailing Address - Fax:410-749-5139
Practice Address - Street 1:1322 BELMONT AVE STE 201
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4593
Practice Address - Country:US
Practice Address - Phone:410-749-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR186099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
S118Medicare PIN
MD119591300Medicaid