Provider Demographics
NPI:1972174704
Name:SPERKO, TRACEY QUELLA (FNP-C)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:QUELLA
Last Name:SPERKO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:ANN
Other - Last Name:QUELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 639295 DEPT 93394
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:484-346-1692
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:2514 S 102ND ST STE 160
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2142
Practice Address - Country:US
Practice Address - Phone:414-395-8650
Practice Address - Fax:855-845-1846
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170866163W00000X
WI13813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13813OtherFAMILY NURSE PRACTITIONER LICENSE