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General NPI Number Information
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NPI Number | 1972889319
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Entity Type | Individual
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Provider Name | TRACY LORETHA DARK FNP
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Gender | Female
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 6091 S QUEBEC ST # 200
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City | CENTENNIAL
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State | CO
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Zip | 80111-4521
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Country | US
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Telephone | 303-641-7280
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Fax | 303-872-3165
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Provider Business Mailing Address
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Address Line | 8801 E HAMPDEN AVE SUITE 110
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City | DENVER
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State | CO
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Zip | 80231
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Country | US
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Telephone | 303-481-8079
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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 | 100036
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License Number State | CO
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