Healthcare Provider Details

I. General information

NPI: 1922530351
Provider Name (Legal Business Name): TRACY BROOKS CRNP-FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N CHARLES ST
BALTIMORE MD
21204-6819
US

IV. Provider business mailing address

3414 FORESTLEIGH DR
OWINGS MILLS MD
21117-2206
US

V. Phone/Fax

Practice location:
  • Phone: 410-938-3000
  • Fax: 410-938-5131
Mailing address:
  • Phone: 443-841-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR183342
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: