Healthcare Provider Details

I. General information

NPI: 1912154816
Provider Name (Legal Business Name): TRACY ANNETTE CROSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4841 MONROE ST STE 202
TOLEDO OH
43623-4352
US

IV. Provider business mailing address

1402 LEITH DR
TOLEDO OH
43614-2613
US

V. Phone/Fax

Practice location:
  • Phone: 419-490-6699
  • Fax: 888-261-3415
Mailing address:
  • Phone: 419-450-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043200
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704253375
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN291991
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: