Healthcare Provider Details

I. General information

NPI: 1831839406
Provider Name (Legal Business Name): TRACY LYNN DOOLEY NP-C, MSN, RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 DELSEA DR N
GLASSBORO NJ
08028-1444
US

IV. Provider business mailing address

62 CHESTNUT RD
BRIDGETON NJ
08302-6511
US

V. Phone/Fax

Practice location:
  • Phone: 856-507-2783
  • Fax: 856-205-0145
Mailing address:
  • Phone: 609-202-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01294900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: