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General NPI Number Information
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NPI Number | 1477699965
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Entity Type | Individual
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Provider Name | TRACY J SHORE MSN,APN,CPNP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 132 FRANKLIN CORNER RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2523
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Country | US
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Telephone | 609-896-3808
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Fax |
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Provider Business Mailing Address
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Address Line | 166 FAIRVIEW RD
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City | SKILLMAN
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State | NJ
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Zip | 08558-1513
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Country | US
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Telephone | 609-712-8200
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | NJ000228
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 26NJ00022800
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License Number State | NJ
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