Healthcare Provider Details

I. General information

NPI: 1871637694
Provider Name (Legal Business Name): TRACIE LYNN ROBERTS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20251 JOHN J WILLIAMS HWY
LEWES DE
19958-4314
US

IV. Provider business mailing address

23557 WILLOW DR
MILLSBORO DE
19966-2891
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-6860
  • Fax: 302-644-6872
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL10027141
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000596
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: