Provider Demographics
NPI:1285983890
Name:TRACY, MELISSA ANN (CRNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:TRACY
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 1:600 MAPLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1436
Mailing Address - Country:US
Mailing Address - Phone:570-253-8635
Mailing Address - Fax:
Practice Address - Street 1:600 MAPLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1436
Practice Address - Country:US
Practice Address - Phone:570-253-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012291363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care