Healthcare Provider Details

I. General information

NPI: 1982020350
Provider Name (Legal Business Name): TRACEY MARIE ALLEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST STE D
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

10 COLUMBUS BLVD FL 4
HARTFORD CT
06106-1976
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-6643
  • Fax: 860-837-6658
Mailing address:
  • Phone: 860-837-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005579
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: