Provider Demographics
NPI:1528610011
Name:JOOST-MOREA, TRACEY L (FNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:JOOST-MOREA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMERSON CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2687
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:631-723-2884
Practice Address - Street 1:1 EMERSON CT
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2687
Practice Address - Country:US
Practice Address - Phone:631-445-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344671-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily