Healthcare Provider Details

I. General information

NPI: 1619160116
Provider Name (Legal Business Name): TRACEY ANN C MITCHELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST 1 PINE WEST
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

800 SPRUCE ST PINE 1 EAST
PHILADELPHIA PA
19107-6130
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-7817
  • Fax: 215-829-7129
Mailing address:
  • Phone: 215-829-7817
  • Fax: 215-829-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP008871
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP015853
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: