Provider Demographics
NPI:1306891254
Name:SHERROD, TRACEY P (ANP-C)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:P
Last Name:SHERROD
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2100 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2818
Mailing Address - Country:US
Mailing Address - Phone:252-847-4100
Mailing Address - Fax:252-291-9110
Practice Address - Street 1:3724 RALEIGH ROAD PKWY W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-9742
Practice Address - Country:US
Practice Address - Phone:252-246-8840
Practice Address - Fax:252-846-8841
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA0206096363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592878Medicare PIN