Healthcare Provider Details

I. General information

NPI: 1417711706
Provider Name (Legal Business Name): TRACY OWUSU FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/25/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 YORK AVE
NEW YORK NY
10021-4800
US

IV. Provider business mailing address

1320 YORK AVE
NEW YORK NY
10021-4800
US

V. Phone/Fax

Practice location:
  • Phone: 917-353-6149
  • Fax:
Mailing address:
  • Phone: 917-353-6149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number635410-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353718
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: