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General NPI Number Information
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NPI Number | 1225254568
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Entity Type | Individual
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Provider Name | TRACY LYNN JALBUENA MD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-706-3280
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Fax | 207-810-2407
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Provider Business Mailing Address
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Address Line | 110 FREE ST
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City | PORTLAND
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State | ME
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Zip | 04101-3908
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Country | US
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Telephone | 207-662-7300
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Fax | 207-301-5288
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 21060
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 57.012103
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD18220
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | MD18220
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License Number State | ME
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