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NPI Code Detail

MEDICARE: TRACY COLEMAN

MEDICARE: TRACY COLEMAN
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
1164W00000XLicensed Practical Nurse266582NY

General Provider Information

NPI Number : 1861054561
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY COLEMAN
Provider Business Mailing Address
First Line : 1413 STONY BROOK RD
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-2214
Country : US
Telephone Number : 631-444-0101
Fax Number : 631-444-0102
Provider Business Practice Location Address
First Line : 1413 STONY BROOK RD
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-2214
Country : US
Telephone Number : 631-444-0101
Fax Number : 631-444-0102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2019
Last Update Date : 07/02/2019

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Directions to “ TRACY COLEMAN ” Practice Location

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