Provider Demographics
NPI:1861257297
Name:WHITNEY, TRACY ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANN
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:GLEN SPEY
Mailing Address - State:NY
Mailing Address - Zip Code:12737-0249
Mailing Address - Country:US
Mailing Address - Phone:845-456-1100
Mailing Address - Fax:845-456-1115
Practice Address - Street 1:1045 PROCTOR RD
Practice Address - Street 2:
Practice Address - City:GLEN SPEY
Practice Address - State:NY
Practice Address - Zip Code:12737-5574
Practice Address - Country:US
Practice Address - Phone:845-456-1100
Practice Address - Fax:845-456-1115
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628407-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse