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General NPI Number Information
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NPI Number | 1770373508
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Entity Type | Individual
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Provider Name | TRACY MARIE ACKLIN RN
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Gender | Female
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 501 S BUENA VISTA ST
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City | BURBANK
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State | CA
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Zip | 91505-4809
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Country | US
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Telephone | 818-847-4043
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 N CENTRAL AVE APT H
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City | GLENDALE
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State | CA
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Zip | 91202-1872
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Country | US
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Telephone | 747-273-3312
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 95057161
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License Number State | CA
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