Provider Demographics
NPI:1851156723
Name:ALLEN, TRACEY ANNE (FNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 BARDS DR SE
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-2200
Mailing Address - Country:US
Mailing Address - Phone:910-477-2834
Mailing Address - Fax:
Practice Address - Street 1:3825 MARKET ST STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1426
Practice Address - Country:US
Practice Address - Phone:910-777-5575
Practice Address - Fax:910-777-5273
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019600363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily