Healthcare Provider Details

I. General information

NPI: 1063858173
Provider Name (Legal Business Name): TRACY OJENIYI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11890 HEALING WAY
SILVER SPRING MD
20904-7917
US

IV. Provider business mailing address

851 TRAFALGAR CT STE 200E
MAITLAND FL
32751-7420
US

V. Phone/Fax

Practice location:
  • Phone: 240-637-4000
  • Fax:
Mailing address:
  • Phone: 407-667-0444
  • Fax: 407-667-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1007894
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR184724
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: