Healthcare Provider Details

I. General information

NPI: 1053385344
Provider Name (Legal Business Name): TRACY L DYSARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20930 DUPONT BLVD UNIT 202
GEORGETOWN DE
19947-1724
US

IV. Provider business mailing address

703 PHILLIPS HILL DR
MILLSBORO DE
19966-1764
US

V. Phone/Fax

Practice location:
  • Phone: 302-202-3438
  • Fax:
Mailing address:
  • Phone: 815-275-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041-265219
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: