Provider Demographics
NPI:1972960961
Name:PROCANYN, TRACIE ANNE (PMHNP)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:ANNE
Last Name:PROCANYN
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1027
Mailing Address - Country:US
Mailing Address - Phone:610-253-2500
Mailing Address - Fax:484-893-3790
Practice Address - Street 1:1803 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1027
Practice Address - Country:US
Practice Address - Phone:610-253-2500
Practice Address - Fax:484-893-3790
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP03178363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health