MEDICARE: MRS. TRACY WORKMAN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	6437	NC
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1114485539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY WORKMAN CRNA

Provider Business Mailing Address
First Line	:	8903 CAMDEN PARK DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-6951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 LAKE BOONE TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7505
Country	:	US
Telephone Number	:	919-784-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	09/17/2020

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