Provider Demographics
NPI:1285105908
Name:COMETA, TRACIE NOELLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:NOELLE
Last Name:COMETA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:NOELLE
Other - Last Name:MAGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:205 HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5729
Mailing Address - Country:US
Mailing Address - Phone:443-553-6069
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR173135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily