MEDICARE: TRACY PACINI

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	C-APN.0001711-C-NP	CO
2	363L00000X	Nurse Practitioner	2014037192	MO
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	277.002228	IL
4	363LF0000X	Family Nurse Practitioner	309.008272	IL

General Provider Information

NPI Number	:	1154727097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY PACINI

Provider Business Mailing Address
First Line	:	50 NORTHGATE INDUSTRIAL DR
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-6805
Country	:	US
Telephone Number	:	618-512-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 N 64TH ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-3809
Country	:	US
Telephone Number	:	618-877-4420
Fax Number	:

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	03/19/2026

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Directions to “ TRACY PACINI ” Practice Location

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