Provider Demographics
NPI:1215313564
Name:HARIPAL, TRACY ANN (RN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:HARIPAL
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 1:149 COMMONWEALTH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-4217
Mailing Address - Country:US
Mailing Address - Phone:516-326-7248
Mailing Address - Fax:
Practice Address - Street 1:149 COMMONWEALTH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-4217
Practice Address - Country:US
Practice Address - Phone:516-326-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY490847163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse