Provider Demographics
NPI:1528244571
Name:WHITE, TRACIE LYN (CRNP/CRNFA)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LYN
Last Name:WHITE
Suffix:
Gender:F
Credentials:CRNP/CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SPRINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-4736
Mailing Address - Country:US
Mailing Address - Phone:205-451-8179
Mailing Address - Fax:
Practice Address - Street 1:1530 3RD AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0002
Practice Address - Country:US
Practice Address - Phone:205-975-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-20
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-086092363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care