Healthcare Provider Details

I. General information

NPI: 1841569613
Provider Name (Legal Business Name): TRACEY-ANN RICKETTS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220A SAINT NICHOLAS AVE
BROOKLYN NY
11237-4807
US

IV. Provider business mailing address

220A SAINT NICHOLAS AVE
BROOKLYN NY
11237-4807
US

V. Phone/Fax

Practice location:
  • Phone: 718-418-8745
  • Fax:
Mailing address:
  • Phone: 718-418-8745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number582107-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number582107-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421014-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: