Basic Information
| Provider Information | |||||||||
| NPI: | 1912958018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 COULTER RD STE 2615 | ||||||||
| Address2: | |||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144321122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154621472 | ||||||||
| FaxNumber: | 3154622639 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 COULTER RD STE 2615 | ||||||||
| Address2: | |||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144321122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154621472 | ||||||||
| FaxNumber: | 3154622639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 11/22/2019 | ||||||||
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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 | 363LA2100X | 430042 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | NP0539 | 01 | NY | PREFERRED CARE | OTHER | 02329793 | 05 | NY | MEDICAID | P019430042 | 01 | NY | BCBS BLUE CHOICE | OTHER |