Healthcare Provider Details

I. General information

NPI: 1336579697
Provider Name (Legal Business Name): TRACEY STONE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACEY STONE FNP-BC

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E PULASKI HWY
ELKTON MD
21921-6435
US

IV. Provider business mailing address

PO BOX 8571
LANCASTER PA
17604-8571
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-3445
  • Fax: 410-620-1538
Mailing address:
  • Phone: 855-834-1466
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0036705
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000720
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC001289
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: