Basic Information
| Provider Information | |||||||||
| NPI: | 1700202520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARLETTA | ||||||||
| FirstName: | TRACIE | ||||||||
| MiddleName: | MAUREEN | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 WAXWING LN | ||||||||
| Address2: | |||||||||
| City: | EAST AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140511624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164819549 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142012135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162428600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2014 | ||||||||
| LastUpdateDate: | 08/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 630703 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 338609 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.