Healthcare Provider Details

I. General information

NPI: 1598580698
Provider Name (Legal Business Name): INNOVATIVE TRAINING AND HEALTHCARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 CHURCH RD
MOUNT LAUREL NJ
08054-1104
US

IV. Provider business mailing address

530 S 2ND ST APT GU-06
PHILADELPHIA PA
19147-2435
US

V. Phone/Fax

Practice location:
  • Phone: 609-828-0524
  • Fax:
Mailing address:
  • Phone: 609-605-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACY LANOZA
Title or Position: PRESIDENT
Credential: APN
Phone: 609-828-0524