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General NPI Number Information
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NPI Number | 1508679044
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Entity Type | Individual
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Provider Name | TRACEY L. CORSO ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 6200 PFEIFFER RD STE 360
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City | MONTGOMERY
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State | OH
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Zip | 45242-5861
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Country | US
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Telephone | 513-862-4957
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Fax | 513-862-4952
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Provider Business Mailing Address
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Address Line | 6200 PFEIFFER RD STE 360
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City | MONTGOMERY
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State | OH
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Zip | 45242-5861
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Country | US
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Telephone | 513-862-4957
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Fax | 513-862-4952
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0038402
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License Number State | OH
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