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General NPI Number Information
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NPI Number | 1902232374
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Entity Type | Individual
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Provider Name | TRACEY GAYLE DECASTRO APRN
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Gender | Female
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 910 DOUGLAS PIKE
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City | SMITHFIELD
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State | RI
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Zip | 02917-1874
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Country | US
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Telephone | 401-427-6727
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Fax | 401-709-7181
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Provider Business Mailing Address
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Address Line | 74 JEREMY HILL RD
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City | STONINGTON
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State | CT
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Zip | 06378-1605
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Country | US
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Telephone | 860-501-1326
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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 | APRN00656
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License Number State | RI
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