MEDICARE: TRACY SMALL APN

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	26NJ00368100	NJ
2	363LF0000X	Family Nurse Practitioner	F339598-01	NY

General Provider Information

NPI Number	:	1467718437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY SMALL APN

Provider Business Mailing Address
First Line	:	120 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-5577
Country	:	US
Telephone Number	:	201-970-4507
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-5577
Country	:	US
Telephone Number	:	646-324-2244
Fax Number	:

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	06/23/2023

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