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General NPI Number Information
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NPI Number | 1790436749
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Entity Type | Individual
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Provider Name | LAUREN MARIE TRACY AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 1021 MOREHEAD MEDICAL DR
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City | CHARLOTTE
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State | NC
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Zip | 28204-2990
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Country | US
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Telephone | 980-442-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 301 29TH AVE N APT 111
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City | NASHVILLE
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State | TN
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Zip | 37203-2273
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Country | US
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Telephone | 615-480-6913
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5015605
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License Number State | NC
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