Healthcare Provider Details

I. General information

NPI: 1770057721
Provider Name (Legal Business Name): TRACY TURNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2019
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 BESTGATE RD STE 2A
ANNAPOLIS MD
21401-3404
US

IV. Provider business mailing address

937 FALL RIDGE WAY
GAMBRILLS MD
21054-1452
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-2116
  • Fax: 410-224-2118
Mailing address:
  • Phone: 410-868-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberR165454
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: