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General NPI Number Information
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NPI Number | 1790219624
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Entity Type | Individual
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Provider Name | TRACEY RENEE THOMAS
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Gender | Female
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 651 US ROUTE 250 E
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City | ASHLAND
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State | OH
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Zip | 44805
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Country | US
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Telephone | 512-800-0048
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Fax |
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Provider Business Mailing Address
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Address Line | 197 ALEXANDER DR
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City | ELYRIA
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State | OH
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Zip | 44035-1833
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Country | US
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Telephone | 440-453-3154
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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 | CNP 020626
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License Number State | OH
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