Provider Demographics
NPI:1972889319
Name:DARK, TRACY LORETHA (FNP)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LORETHA
Last Name:DARK
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:8801 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231
Mailing Address - Country:US
Mailing Address - Phone:303-481-8079
Mailing Address - Fax:
Practice Address - Street 1:6091 S QUEBEC ST # 200
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4521
Practice Address - Country:US
Practice Address - Phone:303-641-7280
Practice Address - Fax:303-872-3165
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO100036363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1972889319OtherNPI