Provider Demographics
NPI:1588268528
Name:GINSBERG, TRACI R (FNP-BC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:R
Last Name:GINSBERG
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 1:5815 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4616
Mailing Address - Country:US
Mailing Address - Phone:818-645-5845
Mailing Address - Fax:
Practice Address - Street 1:5815 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4616
Practice Address - Country:US
Practice Address - Phone:818-645-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily