MEDICARE: TRACY LEE FORD -EPPERSON CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP007509	PA

General Provider Information

NPI Number	:	1063064269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY LEE FORD -EPPERSON CRNP

Provider Business Mailing Address
First Line	:	801 TAFT AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15210-1165
Country	:	US
Telephone Number	:	412-481-1073
Fax Number	:	412-854-8739

Provider Business Practice Location Address
First Line	:	801 TAFT AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15210-1165
Country	:	US
Telephone Number	:	412-481-1073
Fax Number	:	412-854-8739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	07/09/2019

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