MEDICARE: MRS. TRACEY DOUGLASS DOUGLASS

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	163W00000X	Registered Nurse	26NR10394200	NJ

General Provider Information

NPI Number	:	1427382365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACEY DOUGLASS DOUGLASS

Provider Business Mailing Address
First Line	:	64 BAYSIDE CT
Second Line	:
City	:	MARGATE CITY
State	:	NJ
Zip	:	08402-1667
Country	:	US
Telephone Number	:	609-823-8255
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 BAYSIDE CT
Second Line	:
City	:	MARGATE CITY
State	:	NJ
Zip	:	08402-1667
Country	:	US
Telephone Number	:	609-823-8255
Fax Number	:

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

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	05/11/2026

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