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General NPI Number Information
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NPI Number | 1336788850
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Entity Type | Individual
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Provider Name | TRACY KAY O'SHEA APRN-CNP #58842
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Gender | Female
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 2211 LOMAS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2719
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Country | US
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Telephone | 505-272-2111
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Fax |
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Provider Business Mailing Address
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Address Line | 4520 MARTINSBURG RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-3857
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Country | US
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Telephone | 505-385-4981
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 58842
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R64921
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License Number State | NM
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