Provider Demographics
NPI:1063064269
Name:FORD -EPPERSON, TRACY LEE (CRNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:FORD -EPPERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-1165
Mailing Address - Country:US
Mailing Address - Phone:412-481-1073
Mailing Address - Fax:412-854-8739
Practice Address - Street 1:801 TAFT AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-1165
Practice Address - Country:US
Practice Address - Phone:412-481-1073
Practice Address - Fax:412-854-8739
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily