Provider Demographics
NPI:1760026504
Name:HAWSE, TRACY LYNN (PA LLC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:HAWSE
Suffix:
Gender:F
Credentials:PA LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BOW ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2701
Mailing Address - Country:US
Mailing Address - Phone:603-270-9217
Mailing Address - Fax:603-232-1376
Practice Address - Street 1:66 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3506
Practice Address - Country:US
Practice Address - Phone:603-270-9217
Practice Address - Fax:603-232-1376
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH111807-23363LA2200X
CA95013954363LA2200X
FL11004875363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health