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NPI Code Detail

MEDICARE: TRACY L MARTINE CRNP

MEDICARE: TRACY L MARTINE 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
1363L00000XNurse Practitioner343830NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770510778
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY L MARTINE CRNP
Provider Business Mailing Address
First Line : 571 SAINT JOSEPHS BLVD FL 2
Second Line :
City : ELMIRA
State : NY
Zip : 14901-3230
Country : US
Telephone Number : 607-271-2050
Fax Number : 607-873-1244
Provider Business Practice Location Address
First Line : 1138 BROADWAY ST
Second Line :
City : ELMIRA
State : NY
Zip : 14904-2502
Country : US
Telephone Number : 607-734-7982
Fax Number : 607-734-1953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 11/25/2020

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Directions to “ TRACY L MARTINE CRNP” Practice Location

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