Healthcare Provider Details

I. General information

NPI: 1235297987
Provider Name (Legal Business Name): TRACY ROBERTS O'NEIL DNP, C-PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY ROBERTS O'NEIL DNP, CPNP

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MEMORIAL DR
PINEHURST NC
28374-8710
US

IV. Provider business mailing address

PO BOX 3000
PINEHURST NC
28374-3000
US

V. Phone/Fax

Practice location:
  • Phone: 910-715-2164
  • Fax: 910-715-1247
Mailing address:
  • Phone: 910-715-2164
  • Fax: 910-715-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number74607
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: