Provider Demographics
NPI:1326588898
Name:LEER, TRACEY (FNP-BC)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:LEER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-2111
Mailing Address - Country:US
Mailing Address - Phone:856-217-8884
Mailing Address - Fax:
Practice Address - Street 1:1805 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2115
Practice Address - Country:US
Practice Address - Phone:215-467-7666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016946363LS0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool